Patient immobilization and repositioning method and apparatus used in conjunction with charged particle cancer therapy

ABSTRACT

This invention relates generally to treatment of solid cancers. More particularly, the invention relates to a computer controlled patient positioning, immobilization, and repositioning method and apparatus used in conjunction with multi-field charged particle cancer therapy coordinated with patient respiration patterns and further in combination with charged particle beam injection, acceleration, extraction, and/or targeting methods and apparatus.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application:

-   -   is a continuation-in-part of U.S. patent application Ser. No.        12/425,683 filed Apr. 17, 2009, which claims the benefit of:        -   U.S. provisional patent application No. 61/055,395 filed May            22, 2008;        -   U.S. provisional patent application No. 61/137,574 filed            Aug. 1, 2008;        -   U.S. provisional patent application No. 61/192,245 filed            Sep. 17, 2008;        -   U.S. provisional patent application No. 61/055,409 filed May            22, 2008;        -   U.S. provisional patent application No. 61/203,308 filed            Dec. 22, 2008;        -   U.S. provisional patent application No. 61/188,407 filed            Aug. 11, 2008;        -   U.S. provisional patent application No. 61/188,406 filed            Aug. 11, 2008;        -   U.S. provisional patent application No. 61/189,815 filed            Aug. 25, 2008;        -   U.S. provisional patent application No. 61/201,731 filed            Dec. 15, 2008;        -   U.S. provisional patent application No. 61/205,362 filed            Jan. 12, 2009;        -   U.S. provisional patent application No. 61/134,717 filed            Jul. 14, 2008;        -   U.S. provisional patent application No. 61/134,707 filed            Jul. 14, 2008;        -   U.S. provisional patent application No. 61/201,732 filed            Dec. 15, 2008;        -   U.S. provisional patent application No. 61/198,509 filed            Nov. 7, 2008;        -   U.S. provisional patent application No. 61/134,718 filed            Jul. 14, 2008;        -   U.S. provisional patent application No. 61/190,613 filed            Sep. 2, 2008;        -   U.S. provisional patent application No. 61/191,043 filed            Sep. 8, 2008;        -   U.S. provisional patent application No. 61/192,237 filed            Sep. 17, 2008;        -   U.S. provisional patent application No. 61/201,728 filed            Dec. 15, 2008;        -   U.S. provisional patent application No. 61/190,546 filed            Sep. 2, 2008;        -   U.S. provisional patent application No. 61/189,017 filed            Aug. 15, 2008;        -   U.S. provisional patent application No. 61/198,248 filed            Nov. 5, 2008;        -   U.S. provisional patent application No. 61/198,508 filed            Nov. 7, 2008;        -   U.S. provisional patent application No. 61/197,971 filed            Nov. 3, 2008;        -   U.S. provisional patent application No. 61/199,405 filed            Nov. 17, 2008;        -   U.S. provisional patent application No. 61/199,403 filed            Nov. 17, 2008; and        -   U.S. provisional patent application No. 61/199,404 filed            Nov. 17, 2008;    -   claims the benefit of U.S. provisional patent application No.        61/209,529 filed Mar. 9, 2009;    -   claims the benefit of U.S. provisional patent application No.        61/208,182 filed Feb. 23, 2009;    -   claims the benefit of U.S. provisional patent application No.        61/208,971 filed Mar. 3, 2009;    -   claims the benefit of U.S. provisional patent application No.        61/270,298, filed Jul. 7, 2009; and    -   claims priority to PCT patent application serial No.:        PCT/RU2009/00015, filed Mar. 4, 2009,    -   all of which are incorporated herein in their entirety by this        reference thereto.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to treatment of solid cancers. Moreparticularly, the invention relates to a patient immobilization andrepositioning system used in conjunction with multi-field chargedparticle cancer therapy and further in combination with beam injection,acceleration, extraction, and/or targeting methods and apparatus.

2. Discussion of the Prior Art

Cancer Treatment

Proton therapy systems typically include: a beam generator, anaccelerator, and a beam transport system to move the resultingaccelerated protons to a plurality of treatment rooms where the protonsare delivered to a tumor in a patient's body.

Proton therapy works by aiming energetic ionizing particles, such asprotons accelerated with a particle accelerator, onto a target tumor.These particles damage the DNA of cells, ultimately causing their death.Cancerous cells, because of their high rate of division and theirreduced ability to repair damaged DNA, are particularly vulnerable toattack on their DNA.

Due to their relatively enormous size, protons scatter less easily thanX-rays or gamma rays in the tissue and there is very little lateraldispersion. Hence, the proton beam stays focused on the tumor shapewithout much lateral damage to surrounding tissue. All protons of agiven energy have a certain range, defined by the Bragg peak, and thedosage delivery to tissue ratio is maximum over just the last fewmillimeters of the particle's range. The penetration depth depends onthe energy of the particles, which is directly related to the speed towhich the particles were accelerated by the proton accelerator. Thespeed of the proton is adjustable to the maximum rating of theaccelerator. It is therefore possible to focus the cell damage due tothe proton beam at the very depth in the tissues where the tumor issituated. Tissues situated before the Bragg peak receive some reduceddose and tissues situated after the peak receive none.

Patents related to the current invention are summarized here.

Proton Beam Therapy System

F. Cole, et. al. of Loma Linda University Medical Center “Multi-StationProton Beam Therapy System”, U.S. Pat. No. 4,870,287 (Sep. 26, 1989)describe a proton beam therapy system for selectively generating andtransporting proton beams from a single proton source and accelerator toa selected treatment room of a plurality of patient treatment rooms.

Accelerator/Synchrotron

S. Peggs, et. al. “Rapid Cycling Medical Synchrotron and Beam DeliverySystem”, U.S. Pat. No. 7,432,516 (Oct. 7, 2008) describe a synchrotronhaving combined function magnets and a radio frequency (RF) cavityaccelerator. The combined function magnets function to first bend theparticle beam along an orbital path and second focus the particle beam.The RF cavity accelerator is a ferrite loaded cavity adapted for highspeed frequency swings for rapid cycling particle acceleration.

H. Tanaka, et. al. “Charged Particle Accelerator”, U.S. Pat. No.7,259,529 (Aug. 21, 2007) describe a charged particle accelerator havinga two period acceleration process with a fixed magnetic field applied inthe first period and a timed second acceleration period to providecompact and high power acceleration of the charged particles.

T. Haberer, et. al. “Ion Beam Therapy System and a Method for Operatingthe System”, U.S. Pat. No. 6,683,318 (Jan. 27, 2004) describe an ionbeam therapy system and method for operating the system. The ion beamsystem uses a gantry that has a vertical deflection system and ahorizontal deflection system positioned before a last bending magnetthat result in a parallel scanning mode resulting from an edge focusingeffect.

V. Kulish, et. al. “Inductional Undulative EH-Accelerator”, U.S. Pat.No. 6,433,494 (Aug. 13, 2002) describe an inductive undulativeEH-accelerator for acceleration of beams of charged particles. Thedevice consists of an electromagnet undulation system, whose drivingsystem for electromagnets is made in the form of a radio-frequency (RF)oscillator operating in the frequency range from about 100 KHz to 10GHz.

K. Saito, et. al. “Radio-Frequency Accelerating System and Ring TypeAccelerator Provided with the Same”, U.S. Pat. No. 5,917,293 (Jun. 29,1999) describe a radio-frequency accelerating system having a loopantenna coupled to a magnetic core group and impedance adjusting meansconnected to the loop antenna. A relatively low voltage is applied tothe impedance adjusting means allowing small construction of theadjusting means.

J. Hirota, et. al. “Ion Beam Accelerating Device Having SeparatelyExcited Magnetic Cores”, U.S. Pat. No. 5,661,366 (Aug. 26, 1997)describe an ion beam accelerating device having a plurality of highfrequency magnetic field inducing units and magnetic cores.

J. Hirota, et. al. “Acceleration Device for Charged Particles”, U.S.Pat. No. 5,168,241 (Dec. 1, 1992) describe an acceleration cavity havinga high frequency power source and a looped conductor operating under acontrol that combine to control a coupling constant and/or de-tuningallowing transmission of power more efficiently to the particles.

Extraction

T. Nakanishi, et. al. “Charged-Particle Beam Accelerator, Particle BeamRadiation Therapy System Using the Charged-Particle Beam Accelerator,and Method of Operating the Particle Beam Radiation Therapy System”,U.S. Pat. No. 7,122,978 (Oct. 17, 2006) describe a charged particle beamaccelerator having an RF-KO unit for increasing amplitude of betatronoscillation of a charged particle beam within a stable region ofresonance and an extraction quadrupole electromagnet unit for varying astable region of resonance. The RF-KO unit is operated within afrequency range in which the circulating beam does not go beyond aboundary of stable region of resonance and the extraction quadrupoleelectromagnet is operated with timing required for beam extraction.

T. Haberer, et. al. “Method and Device for Controlling a Beam ExtractionRaster Scan Irradiation Device for Heavy Ions or Protons”, U.S. Pat. No.7,091,478 (Aug. 15, 2006) describe a method for controlling beamextraction in terms of beam energy, beam focusing, and beam intensityfor every accelerator cycle.

K. Hiramoto, et. al. “Accelerator and Medical System and OperatingMethod of the Same”, U.S. Pat. No. 6,472,834 (Oct. 29, 2002) describe acyclic type accelerator having a deflection electromagnet and four-poleelectromagnets for making a charged particle beam circulate, amulti-pole electromagnet for generating a stability limit of resonanceof betatron oscillation, and a high frequency source for applying a highfrequency electromagnetic field to the beam to move the beam to theoutside of the stability limit. The high frequency source generates asum signal of a plurality of alternating current (AC) signals of whichthe instantaneous frequencies change with respect to time, and of whichthe average values of the instantaneous frequencies with respect to timeare different. The system applies the sum signal via electrodes to thebeam.

K. Hiramoto, et. al. “Synchrotron Type Accelerator and Medical TreatmentSystem Employing the Same”, U.S. Pat. No. 6,087,670 (Jul. 11, 2000) andK. Hiramoto, et. al. “Synchrotron Type Accelerator and Medical TreatmentSystem Employing the Same”, U.S. Pat. No. 6,008,499 (Dec. 28, 1999)describe a synchrotron accelerator having a high frequency applying unitarranged on a circulating orbit for applying a high frequencyelectromagnetic field to a charged particle beam circulating and forincreasing amplitude of betatron oscillation of the particle beam to alevel above a stability limit of resonance. Additionally, for beamejection, four-pole divergence electromagnets are arranged: (1)downstream with respect to a first deflector; (2) upstream with respectto a deflecting electromagnet; (3) downstream with respect to thedeflecting electromagnet; and (4) and upstream with respect to a seconddeflector.

K. Hiramoto, et. al. “Circular Accelerator and Method and Apparatus forExtracting Charged-Particle Beam in Circular Accelerator”, U.S. Pat. No.5,363,008 (Nov. 8, 1994) describe a circular accelerator for extractinga charged-particle beam that is arranged to: (1) increase displacementof a beam by the effect of betatron oscillation resonance; (2) toincrease the betatron oscillation amplitude of the particles, which havean initial betatron oscillation within a stability limit for resonance;and (3) to exceed the resonance stability limit thereby extracting theparticles exceeding the stability limit of the resonance.

K. Hiramoto, et. al. “Method of Extracting Charged Particles fromAccelerator, and Accelerator Capable Carrying Out the Method, byShifting Particle Orbit”, U.S. Pat. No. 5,285,166 (Feb. 8, 1994)describe a method of extracting a charged particle beam. An equilibriumorbit of charged particles maintained by a bending magnet and magnetshaving multipole components greater than sextuple components is shiftedby a constituent element of the accelerator other than these magnets tochange the tune of the charged particles.

Gantry

T. Yamashita, et. al. “Rotating Irradiation Apparatus”, U.S. Pat. No.7,381,979 (Jun. 3, 2008) describe a rotating gantry having a front ringand a rear ring, each ring having radial support devices, where theradial support devices have linear guides. The system has thrust supportdevices for limiting movement of the rotatable body in the direction ofthe rotational axis of the rotatable body.

T. Yamashita, et. al. “Rotating Gantry of Particle Beam Therapy System”U.S. Pat. No. 7,372,053 (May 13, 2008) describe a rotating gantrysupported by an air braking system allowing quick movement, braking, andstopping of the gantry during irradiation treatment.

M. Yanagisawa, et. al. “Medical Charged Particle Irradiation Apparatus”,U.S. Pat. No. 6,992,312 (Jan. 31, 2006); M. Yanagisawa, et. al. “MedicalCharged Particle Irradiation Apparatus”, U.S. Pat. No. 6,979,832 (Dec.27, 2005); and M. Yanagisawa, et. al. “Medical Charged ParticleIrradiation Apparatus”, U.S. Pat. No. 6,953,943 (Oct. 11, 2005) alldescribe an apparatus capable of irradiation from upward and horizontaldirections. The gantry is rotatable about an axis of rotation where theirradiation field forming device is eccentrically arranged, such that anaxis of irradiation passes through a different position than the axis ofrotation.

H. Kaercher, et. al. “Isokinetic Gantry Arrangement for the IsocentricGuidance of a Particle Beam And a Method for Constructing Same”, U.S.Pat. No. 6,897,451 (May 24, 2005) describe an isokinetic gantryarrangement for isocentric guidance of a particle beam that can berotated around a horizontal longitudinal axis.

G. Kraft, et. al. “Ion Beam System for Irradiating Tumor Tissues”, U.S.Pat. No. 6,730,921 (May 4, 2004) describe an ion beam system forirradiating tumor tissues at various irradiation angles in relation to ahorizontally arranged patient couch, where the patient couch isrotatable about a center axis and has a lifting mechanism. The systemhas a central ion beam deflection of up to ±15 degrees with respect to ahorizontal direction.

M. Pavlovic, et. al. “Gantry System and Method for Operating Same”, U.S.Pat. No. 6,635,882 (Oct. 21, 2003) describe a gantry system foradjusting and aligning an ion beam onto a target from a freelydeterminable effective treatment angle. The ion beam is aligned on atarget at adjustable angles of from 0 to 360 degrees around the gantryrotation axis and at an angle of 45 to 90 degrees off of the gantryrotation axis yielding a cone of irradiation when rotated a fullrevolution about the gantry rotation axis.

Movable Patient

N. Rigney, et. al. “Patient Alignment System with External Measurementand Object Coordination for Radiation Therapy System”, U.S. Pat. No.7,199,382 (Apr. 3, 2007) describe a patient alignment system for aradiation therapy system that includes multiple external measurementdevices that obtain position measurements of movable components of theradiation therapy system. The alignment system uses the externalmeasurements to provide corrective positioning feedback to moreprecisely register the patient to the radiation beam.

Y. Muramatsu, et. al. “Medical Particle Irradiation Apparatus”, U.S.Pat. No. 7,030,396 (Apr. 18, 2006); Y. Muramatsu, et. al. “MedicalParticle Irradiation Apparatus”, U.S. Pat. No. 6,903,356 (Jun. 7, 2005);and Y. Muramatsu, et. al. “Medical Particle Irradiation Apparatus”, U.S.Pat. No. 6,803,591 (Oct. 12, 2004) all describe a medical particleirradiation apparatus having a rotating gantry, an annular frame locatedwithin the gantry such that it can rotate relative to the rotatinggantry, an anti-correlation mechanism to keep the frame from rotatingwith the gantry, and a flexible moving floor engaged with the frame insuch a manner to move freely with a substantially level bottom while thegantry rotates.

H. Nonaka, et. al. “Rotating Radiation Chamber for Radiation Therapy”,U.S. Pat. No. 5,993,373 (Nov. 30, 1999) describe a horizontal movablefloor composed of a series of multiple plates that are connected in afree and flexible manner, where the movable floor is moved in synchronywith rotation of a radiation beam irradiation section.

Respiration

K. Matsuda “Radioactive Beam Irradiation Method and Apparatus TakingMovement of the Irradiation Area Into Consideration”, U.S. Pat. No.5,538,494 (Jul. 23, 1996) describes a method and apparatus that enablesirradiation even in the case of a diseased part changing position due tophysical activity, such as respiration and heart beat. Initially, aposition change of a diseased body part and physical activity of thepatient are measured concurrently and a relationship therebetween isdefined as a function. Radiation therapy is performed in accordance tothe function.

Patient Positioning

Y. Nagamine, et. al. “Patient Positioning Device and Patient PositioningMethod”, U.S. Pat. No. 7,212,609 (May 1, 2007) and Y. Nagamine, et. al.“Patient Positioning Device and Patient Positioning Method”, U.S. Pat.No. 7,212,608 (May 1, 2007) describe a patient positioning system thatcompares a comparison area of a reference X-ray image and a currentX-ray image of a current patient location using pattern matching.

D. Miller, et. al. “Modular Patient Support System”, U.S. Pat. No.7,173,265 (Feb. 6, 2007) describe a radiation treatment system having apatient support system that includes a modularly expandable patient podand at least one immobilization device, such as a moldable foam cradle.

K. Kato, et. al. “Multi-Leaf Collimator and Medical System IncludingAccelerator”, U.S. Pat. No. 6,931,100 (Aug. 16, 2005); K. Kato, et. al.“Multi-Leaf Collimator and Medical System Including Accelerator”, U.S.Pat. No. 6,823,045 (Nov. 23, 2004); K. Kato, et. al. “Multi-LeafCollimator and Medical System Including Accelerator”, U.S. Pat. No.6,819,743 (Nov. 16, 2004); and K. Kato, et. al. “Multi-Leaf Collimatorand Medical System Including Accelerator”, U.S. Pat. No. 6,792,078 (Sep.14, 2004) all describe a system of leaf plates used to shortenpositioning time of a patient for irradiation therapy. Motor drivingforce is transmitted to a plurality of leaf plates at the same timethrough a pinion gear. The system also uses upper and lower aircylinders and upper and lower guides to position a patient.

Computer Control

A. Beloussov et. al. “Configuration Management and Retrieval System forProton Beam Therapy System”, U.S. Pat. No. 7,368,740 (May 6, 2008); A.Beloussov et. al. “Configuration Management and Retrieval System forProton Beam Therapy System”, U.S. Pat. No. 7,084,410 (Aug. 1, 2006); andA. Beloussov et. al. “Configuration Management and Retrieval System forProton Beam Therapy System”, U.S. Pat. No. 6,822,244 (Nov. 23, 2004) alldescribe a multi-processor software controlled proton beam system havingtreatment configurable parameters that are easily modified by anauthorized user to prepare the software controlled system for variousmodes of operation to insure that data and configuration parameters areaccessible if single point failures occur in the database.

J. Hirota et. al. “Automatically Operated Accelerator Using ObtainedOperating Patterns”, U.S. Pat. No. 5,698,954 (Dec. 16, 1997) describes amain controller for determining the quantity of control and the controltiming of every component of an accelerator body with the controlscoming from an operating pattern.

Problem

There exists in the art of a need for accurate and precise delivery ofBragg peak energy to a tumor. More particularly, there exists a need toposition, immobilize, and reproducibly position a person relative to animaging beam system, such as an X-ray, and to reproducibly position thepatient relative to a particle therapy beam. Preferably, the systemwould operate in conjunction with a negative ion beam source,synchrotron, and/or targeting method apparatus to provide an X-ray timedwith patient respiration and performed immediately prior to and/orconcurrently with particle beam therapy irradiation to ensure targetedand controlled delivery of energy relative to a patient position.Further, there exists a need in the art to control the charged particlecancer therapy system in terms of specified energy, intensity, and/ortiming of charged particle delivery relative to a patient position.Still further, there exists a need for efficient, precise, and/oraccurate in-vivo treatment of a solid cancerous tumor with minimizationof damage to surrounding healthy tissue in a patient using the protonbeam position verification system.

SUMMARY OF THE INVENTION

The invention comprises a patient immobilization and automatedrepositioning method and apparatus used in combination with amulti-field irradiation charged particle cancer therapy system andpreferably in combination with charged particle beam injection,acceleration, extraction, and/or targeting methods and apparatus.

DESCRIPTION OF THE FIGURES

FIG. 1 illustrates component connections of a charged particle beamtherapy system;

FIG. 2 illustrates a charged particle therapy system;

FIG. 3 illustrates an ion beam generation system;

FIG. 4 illustrates a negative ion beam source;

FIG. 5 illustrates an ion beam focusing system;

FIGS. 6 A-D illustrate focusing electrodes about a negative ion beampath;

FIG. 7A illustrates a negative ion beam path vacuum system;

FIG. 7B illustrates a support structure and foil;

FIG. 7C illustrates the foil;

FIG. 8 is a particle beam therapy control flowchart;

FIG. 9 illustrates straight and turning sections of a synchrotron

FIG. 10 illustrates bending magnets of a synchrotron;

FIG. 11 provides a perspective view of a bending magnet;

FIG. 12 illustrates a cross-sectional view of a bending magnet;

FIG. 13 illustrates a cross-sectional view of a bending magnet;

FIG. 14 illustrates magnetic field concentration in a bending magnet;

FIG. 15 illustrates correction coils in a bending magnet;

FIG. 16 illustrates a magnetic turning section of a synchrotron;

FIGS. 17A and B illustrate an RF accelerator and an RF acceleratorsubsystem, respectively;

FIG. 18 illustrates a magnetic field control system;

FIG. 19 illustrates a charged particle extraction and intensity controlsystem;

FIGS. 20 A and B illustrate proton beam position verification systems;

FIG. 21 illustrates a patient positioning system from: (A) a front viewand (B) a top view;

FIG. 22 provides X-ray and proton beam dose distributions;

FIGS. 23 A-E illustrate controlled scanning and depth of focusirradiation;

FIGS. 24 A-E illustrate multi-field irradiation;

FIG. 25 illustrates dose efficiency enhancement via use of multi-fieldirradiation;

FIG. 26 provides two methods of multi-field irradiation implementation;

FIG. 27 illustrates multi-dimensional scanning of a charged particlebeam spot scanning system operating on: (A) a 2-D slice or (B) a 3-Dvolume of a tumor;

FIG. 28 illustrates an electron gun source used in generating X-rayscoupled with a particle beam therapy system;

FIG. 29 illustrates an X-ray source proximate a particle beam path;

FIG. 30 illustrates an expanded X-ray beam path;

FIG. 31 provides an X-ray tomography system;

FIG. 32 illustrates a semi-vertical patient positioning system;

FIG. 33 provides an example of a sitting patient positioning system;

FIG. 34 illustrates a laying patient positioning system;

FIG. 35 illustrates a head restraint system;

FIG. 36 illustrates hand and head supports;

FIG. 37 provides a method of coordinating X-ray collection with patientrespiration; and

FIG. 38 illustrates a patient positioning, immobilization, andrepositioning system.

DETAILED DESCRIPTION OF THE INVENTION

The invention relates generally to treatment of solid cancers. Moreparticularly, the invention relates to a patient positioning,immobilization, and repositioning method and apparatus used incombination with a multi-field irradiation charged particle cancertherapy system including: beam injection, acceleration, extraction,imaging, and/or targeting components.

Used in combination with the invention, novel design features of acharged particle beam cancer therapy system are described. Particularly,a negative ion beam source with novel features in the negative ionsource, ion source vacuum system, ion beam focusing lens, and tandemaccelerator is described. Additionally, the synchrotron includes:turning magnets, edge focusing magnets, magnetic field concentrationmagnets, winding and correction coils, flat magnetic field incidentsurfaces, and extraction elements, which minimize the overall size ofthe synchrotron, provide a tightly controlled proton beam, directlyreduce the size of required magnetic fields, directly reduce requiredoperating power, and allow continual acceleration of protons in asynchrotron even during a process of extracting protons from thesynchrotron. The ion beam source system and synchrotron are preferablycomputer integrated with a patient imaging system and a patientinterface including respiration monitoring sensors and patientpositioning elements. Further, the system is integrated with intensitycontrol of a charged particle beam, acceleration, extraction, and/ortargeting method and apparatus. More particularly, intensity, energy,and timing control of a charged particle stream of a synchrotron iscoordinated with patient positioning and tumor treatment. Thesynchrotron control elements allow tight control of the charged particlebeam, which compliments the tight control of patient positioning toyield efficient treatment of a solid tumor with reduced tissue damage tosurrounding healthy tissue. In addition, the system reduces the overallsize of the synchrotron, provides a tightly controlled proton beam,directly reduces the size of required magnetic fields, directly reducesrequired operating power, and allows continual acceleration of protonsin a synchrotron even during a process of extracting protons from thesynchrotron. All of these systems are preferably used in conjunctionwith an X-ray system capable of collecting X-rays of a patient: (1) in apositioning, immobilization, and automated repositioning system forproton treatment; (2) at a specified moment of the patient's respirationcycle; and (3) using coordinated translation and rotation of thepatient. Combined, the systems provide for efficient, accurate, andprecise noninvasive tumor treatment with minimal damage to surroundinghealthy tissue.

In one embodiment, a treatment delivery control system (TDCS) or maincontroller is used to control multiple aspects of the cancer therapysystem, including one or more of: an imaging system, such as a CT orPET; a positioner, such as a couch or patient interface module; aninjector or injection system; a ring accelerator or synchrotron; anextraction system; an irradiation plan; and a display system. The TDCSis preferably a control system for automated cancer therapy once thepatient is positioned. The TDCS integrates output of one or more of theabove described cancer therapy system elements with inputs of one ormore of the above described cancer therapy system elements. Moregenerally, the TDCS controls or manages input and/or output of imaging,an irradiation plan, and charged particle delivery.

Charged Particle Beam Therapy

Throughout this document, a charged particle beam therapy system, suchas a proton beam, hydrogen ion beam, or carbon ion beam, is described.Herein, the charged particle beam therapy system is described using aproton beam. However, the aspects taught and described in terms of aproton beam are not intended to be limiting to that of a proton beam andare illustrative of a charged particle beam system. Any of thetechniques described herein are equally applicable to any chargedparticle beam system.

Referring now to FIG. 1, a charged particle beam system 100 isillustrated. The charged particle beam preferably comprises a number ofsubsystems including any of: a main controller 110; an injection system120; a synchrotron 130 that typically includes: (1) an acceleratorsystem 132 and (2) an extraction system 134; ascanning/targeting/delivery system 140; a patient interface module 150;a display system 160; and/or an imaging system 170.

An exemplary method of use of the charged particle beam system 100 isprovided. The main controller 110 controls one or more of the subsystemsto accurately and precisely deliver protons to a tumor of a patient. Forexample, the main controller 110 obtains an image, such as a portion ofa body and/or of a tumor, from the imaging system 170. The maincontroller 110 also obtains position and/or timing information from thepatient interface module 150. The main controller 110 then optionallycontrols the injection system 120 to inject a proton into a synchrotron130. The synchrotron typically contains at least an accelerator system132 and an extraction system 134. The main controller preferablycontrols the proton beam within the accelerator system, such as bycontrolling speed, trajectory, and timing of the proton beam. The maincontroller then controls extraction of a proton beam from theaccelerator through the extraction system 134. For example, thecontroller controls timing, energy, and/or intensity of the extractedbeam. The controller 110 also preferably controls targeting of theproton beam through the scanning/targeting/delivery system 140 to thepatient interface module 150. One or more components of the patientinterface module 150, such as translational and rotational position ofthe patient, are preferably controlled by the main controller 110.Further, display elements of the display system 160 are preferablycontrolled via the main controller 110. Displays, such as displayscreens, are typically provided to one or more operators and/or to oneor more patients. In one embodiment, the main controller 110 times thedelivery of the proton beam from all systems, such that protons aredelivered in an optimal therapeutic manner to the tumor of the patient.

Herein, the main controller 110 refers to a single system controllingthe charged particle beam system 100, to a single controller controllinga plurality of subsystems controlling the charged particle beam system100, or to a plurality of individual controllers controlling one or moresub-systems of the charged particle beam system 100.

Referring now to FIG. 2, an illustrative exemplary embodiment of oneversion of the charged particle beam system 100 is provided. The number,position, and described type of components is illustrative andnon-limiting in nature. In the illustrated embodiment, the injectionsystem 120 or ion source or charged particle beam source generatesprotons. The protons are delivered into a vacuum tube that runs into,through, and out of the synchrotron. The generated protons are deliveredalong an initial path 262. Focusing magnets 230, such as quadrupolemagnets or injection quadrupole magnets, are used to focus the protonbeam path. A quadrupole magnet is a focusing magnet. An injector bendingmagnet 232 bends the proton beam toward the plane of the synchrotron130. The focused protons having an initial energy are introduced into aninjector magnet 240, which is preferably an injection Lamberson magnet.Typically, the initial beam path 262 is along an axis off of, such asabove, a circulating plane of the synchrotron 130. The injector bendingmagnet 232 and injector magnet 240 combine to move the protons into thesynchrotron 130. Main bending magnets, dipole magnets, or circulatingmagnets 250 are used to turn the protons along a circulating beam path264. A dipole magnet is a bending magnet. The main bending magnets 250bend the initial beam path 262 into a circulating beam path 264. In thisexample, the main bending magnets 250 or circulating magnets arerepresented as four sets of four magnets to maintain the circulatingbeam path 264 into a stable circulating beam path. However, any numberof magnets or sets of magnets are optionally used to move the protonsaround a single orbit in the circulation process. The protons passthrough an accelerator 270. The accelerator accelerates the protons inthe circulating beam path 264. As the protons are accelerated, thefields applied by the magnets are increased. Particularly, the speed ofthe protons achieved by the accelerator 270 are synchronized withmagnetic fields of the main bending magnets 250 or circulating magnetsto maintain stable circulation of the protons about a central point orregion 280 of the synchrotron. At separate points in time theaccelerator 270/main bending magnet 250 combination is used toaccelerate and/or decelerate the circulating protons while maintainingthe protons in the circulating path or orbit. An extraction element ofthe inflector/deflector system 290 is used in combination with aLamberson extraction magnet 292 to remove protons from their circulatingbeam path 264 within the synchrotron 130. One example of a deflectorcomponent is a Lamberson magnet. Typically the deflector moves theprotons from the circulating plane to an axis off of the circulatingplane, such as above the circulating plane. Extracted protons arepreferably directed and/or focused using an extraction bending magnet237 and extraction focusing magnets 235, such as quadrupole magnetsalong a transport path 268 into the scanning/targeting/delivery system140. Two components of a scanning system 140 or targeting systemtypically include a first axis control 142, such as a vertical control,and a second axis control 144, such as a horizontal control. In oneembodiment, the first axis control 142 allows for about 100 mm ofvertical or y-axis scanning of the proton beam 268 and the second axiscontrol 144 allows for about 700 mm of horizontal or x-axis scanning ofthe proton beam 268. A nozzle system 146 is used for imaging the protonbeam and/or as a vacuum barrier between the low pressure beam path ofthe synchrotron and the atmosphere. Protons are delivered with controlto the patient interface module 150 and to a tumor of a patient. All ofthe above listed elements are optional and may be used in variouspermutations and combinations. Each of the above listed elements arefurther described, infra.

Ion Beam Generation System

An ion beam generation system generates a negative ion beam, such as ahydrogen anion or H⁻ beam; preferably focuses the negative ion beam;converts the negative ion beam to a positive ion beam, such as a protonor H⁺ beam; and injects the positive ion beam 262 into the synchrotron130. Portions of the ion beam path are preferably under partial vacuum.Each of these systems are further described, infra.

Referring now to FIG. 3, an exemplary ion beam generation system 300 isillustrated. As illustrated, the ion beam generation system 300 has fourmajor subsections: a negative ion source 310, a first partial vacuumsystem 330, an optional ion beam focusing system 350, and a tandemaccelerator 390.

Still referring to FIG. 3, the negative ion source 310 preferablyincludes an inlet port 312 for injection of hydrogen gas into a hightemperature plasma chamber 314. In one embodiment, the plasma chamberincludes a magnetic material 316, which provides a magnetic field 317between the high temperature plasma chamber 314 and a low temperatureplasma region on the opposite side of the magnetic field barrier. Anextraction pulse is applied to a negative ion extraction electrode 318to pull the negative ion beam into a negative ion beam path 319, whichproceeds through the first partial vacuum system 330, through the ionbeam focusing system 350, and into the tandem accelerator 390.

Still referring to FIG. 3, the first partial vacuum system 330 is anenclosed system running from the hydrogen gas inlet port 312 to a foil395 in the tandem accelerator 390. The foil 395 is preferably sealeddirectly or indirectly to the edges of the vacuum tube 320 providing fora higher pressure, such as about 10⁻⁵ torr, to be maintained on thefirst partial vacuum system 330 side of the foil 395 and a lowerpressure, such as about 10⁻⁷ torr, to be maintained on the synchrotronside of the foil 390. By only pumping first partial vacuum system 330and by only semi-continuously operating the ion beam source vacuum basedon sensor readings, the lifetime of the semi-continuously operating pumpis extended. The sensor readings are further described, infra.

Still referring to FIG. 3, the first partial vacuum system 330preferably includes: a first pump 332, such as a continuously operatingpump and/or a turbo molecular pump; a large holding volume 334; and asemi-continuously operating pump 336. Preferably, a pump controller 340receives a signal from a pressure sensor 342 monitoring pressure in thelarge holding volume 334. Upon a signal representative of a sufficientpressure in the large holding volume 334, the pump controller 340instructs an actuator 345 to open a valve 346 between the large holdingvolume and the semi-continuously operating pump 336 and instructs thesemi-continuously operating pump to turn on and pump to atmosphereresidual gases out of the vacuum line 320 about the charged particlestream. In this fashion, the lifetime of the semi-continuously operatingpump is extended by only operating semi-continuously and as needed. Inone example, the semi-continuously operating pump 336 operates for a fewminutes every few hours, such as 5 minutes every 4 hours, therebyextending a pump with a lifetime of about 2,000 hours to about 96,000hours.

Further, by isolating the inlet gas from the synchrotron vacuum system,the synchrotron vacuum pumps, such as turbo molecular pumps can operateover a longer lifetime as the synchrotron vacuum pumps have fewer gasmolecules to deal with. For example, the inlet gas is primarily hydrogengas but may contain impurities, such as nitrogen and carbon dioxide. Byisolating the inlet gases in the negative ion source system 310, firstpartial vacuum system 330, ion beam focusing system 350, and negativeion beam side of the tandem accelerator 390, the synchrotron vacuumpumps can operate at lower pressures with longer lifetimes, whichincreases operating efficiency of the synchrotron 130.

Still referring to FIG. 3, the optimal ion beam focusing system 350preferably includes two or more electrodes where one electrode of eachelectrode pair partially obstructs the ion beam path with conductivepaths 372, such as a conductive mesh. In the illustrated example, twoion beam focusing system sections are illustrated, a two electrode ionbeam focusing section 360 and a three electrode ion beam focusingsection. For a given electrode pair, electric field lines, runningbetween the conductive mesh of a first electrode and a second electrode,provide inward forces focusing the negative ion beam. Multiple suchelectrode pairs provide multiple negative ion beam focusing regions.Preferably the two electrode ion focusing section 360, a first threeelectrode ion focusing section 370, and a second three electrode ionfocusing section are placed after the negative ion source and before thetandem accelerator and/or cover a space of about 0.5, 1, or 2 metersalong the ion beam path 319. Ion beam focusing systems are furtherdescribed, infra.

Still referring to FIG. 3, the tandem accelerator 390 preferablyincludes a foil 395, such as a carbon foil. The negative ions in thenegative ion beam path 319 are converted to positive ions, such asprotons, and the initial ion beam path 262 results. The foil 395 ispreferably sealed directly or indirectly to the edges of the vacuum tube320 providing for a higher pressure, such as about 10⁻⁵ torr, to bemaintained on the side of the foil 395 having the negative ion beam path319 and a lower pressure, such as about 10⁻⁷ torr, to be maintained onthe side of the foil 390 having the proton ion beam path 262. Having thefoil 395 physically separating the vacuum chamber 320 into two pressureregions allows for a system having fewer and/or smaller pumps tomaintain the lower pressure system in the synchrotron 130 as the inlethydrogen and its residuals are extracted in a separate contained andisolated space by the first partial vacuum system 330.

Negative Ion Source

An example of the negative ion source 310 is further described herein.Referring now to FIG. 4, a cross-section of an exemplary negative ionsource system 400 is provided. The negative ion beam 319 is created inmultiple stages. During a first stage, hydrogen gas is injected into achamber. During a second stage, a negative ion is created by applicationof a first high voltage pulse, which creates a plasma about the hydrogengas to create negative ions. During a third stage, a magnetic fieldfilter is applied to components of the plasma. During a fourth stage,the negative ions are extracted from a low temperature plasma region, onthe opposite side of the magnetic field barrier, by application of asecond high voltage pulse. Each of the four stages are furtherdescribed, infra. While the chamber is illustrated as a cross-section ofa cylinder, the cylinder is exemplary only and any geometry applies tothe magnetic loop containment walls, described infra.

In the first stage, hydrogen gas 440 is injected through the inlet port312 into a high temperature plasma region 490. The injection port 312 isopen for a short period of time, such as less than about 1, 5, or 10microseconds to minimize vacuum pump requirements to maintain vacuumchamber 320 requirements. The high temperature plasma region ismaintained at reduced pressure by the partial vacuum system 330. Theinjection of the hydrogen gas is optionally controlled by the maincontroller 110, which is responsive to imaging system 170 informationand patient interface module 150 information, such as patientpositioning and period in a respiration cycle.

In the second stage, a high temperature plasma region is created byapplying a first high voltage pulse across a first electrode 422 and asecond electrode 424. For example a 5 kV pulse is applied for about 20microseconds with 5 kV at the second electrode 424 and about 0 kVapplied at the first electrode 422. Hydrogen in the chamber is broken,in the high temperature plasma region 490, into component parts, such asany of: atomic hydrogen, H⁰, a proton, H⁺, an electron, e⁻, and ahydrogen anion, H⁻.

In the third stage, the high temperature plasma region 490 is at leastpartially separated from a low temperature plasma region 492 by themagnetic field 317 or in this specific example a magnetic field barrier430. High energy electrons are restricted from passing through themagnetic field barrier 430. In this manner, the magnetic field barrier430 acts as a filter between, zone A and zone B, in the negative ionsource. Preferably, a central magnetic material 410, which is an exampleof the magnetic material 316, is placed within the high temperatureplasma region 490, such as along a central axis of the high temperatureplasma region 490. Preferably, the first electrode 422 and secondelectrode 424 are composed of magnetic materials, such as iron.Preferably, the outer walls 450 of the high temperature plasma region,such as cylinder walls, are composed of a magnetic material, such as apermanent magnet, ferric or iron based material, or a ferrite dielectricring magnet. In this manner a magnetic field loop is created by: thecentral magnetic material 410, first electrode 422, the outer walls 450,the second electrode 424, and the magnetic field barrier 430. Again, themagnetic field barrier 430 restricts high energy electrons from passingthrough the magnetic field barrier 430. Low energy electrons interactwith atomic hydrogen, H⁰, to create a hydrogen anion, H⁻, in the lowtemperature plasma region 492.

In the fourth stage, a second high voltage pulse or extraction pulse isapplied at a third electrode 426. The second high voltage pulse ispreferentially applied during the later period of application of thefirst high voltage pulse. For example, an extraction pulse of about 25kV is applied for about the last 5 microseconds of the first creationpulse of about 20 microseconds. The potential difference, of about 20kV, between the third electrode 426 and second electrode 424 extractsthe negative ion, H⁻, from the low temperature plasma region 492 andinitiates the negative ion beam 319, from zone B to zone C.

The magnetic field barrier 430 is optionally created in number of ways.An example of creation of the magnetic field barrier 430 using coils isprovided. In this example, the elements described, supra, in relation toFIG. 4 are maintained with several differences. First, the magneticfield is created using coils. An isolating material is preferablyprovided between the first electrode 422 and the cylinder walls 450 aswell as between the second electrode 424 and the cylinder walls 450. Thecentral material 410 and/or cylinder walls 450 are optionally metallic.In this manner, the coils create a magnetic field loop through the firstelectrode 422, isolating material, outer walls 450, second electrode424, magnetic field barrier 430, and the central material 410.Essentially, the coils generate a magnetic field in place of productionof the magnetic field by the magnetic material 410. The magnetic fieldbarrier 430 operates as described, supra. Generally, any manner thatcreates the magnetic field barrier 430 between the high temperatureplasma region 490 and low temperature plasma region 492 is functionallyapplicable to the ion beam extraction system 400, described herein.

Ion Beam Focusing System

Referring now to FIG. 5, the ion beam focusing system 350 is furtherdescribed. In this example, three electrodes are used. In this example,a first electrode 510 and third electrode 530 are both negativelycharged and each is a ring electrode circumferentially enclosing or atleast partially enclosing the negative ion beam path 319. A secondelectrode 520 is positively charged and is also a ring electrode atleast partially and preferably substantially circumferentially enclosingthe negative ion beam path. In addition, the second electrode includesone or more conducting paths 372 running through the negative ion beampath 319. For example, the conducting paths are a wire mesh, aconducting grid, or a series of substantially parallel conducting linesrunning across the second electrode. In use, electric field lines runfrom the conducting paths of the positively charged electrode to thenegatively charged electrodes. For example, in use the electric fieldlines 540 run from the conducting paths 372 in the negative ion beampath 319 to the negatively charged electrodes 510, 530. Two ray tracelines 550, 560 of the negative ion beam path are used to illustratefocusing forces. In the first ray trace line 550, the negative ion beamencounters a first electric field line at point M. Negatively chargedions in the negative ion beam 550 encounter forces running up theelectric field line 572, illustrated with an x-axis component vector571. The x-axis component force vectors 571 alters the trajectory of thefirst ray trace line to a inward focused vector 552, which encounters asecond electric field line at point N. Again, the negative ion beam 552encounters forces running up the electric field line 574, illustrated ashaving an inward force vector with an x-axis component 573, which altersthe inward focused vector 552 to a more inward focused vector 554.Similarly, in the second ray trace line 560, the negative ion beamencounters a first electric field line at point O. Negatively chargedions in the negative ion beam encounter forces running up the electricfield line 576, illustrated as having a force vector with an x-axisforce 575. The inward force vector 575 alters the trajectory of thesecond ray trace line 560 to an inward focused vector 562, whichencounters a second electric field line at point P. Again, the negativeion beam encounters forces running up the electric field line 578,illustrated as having force vector with an x-axis component 577, whichalters the inward focused vector 562 to a more inward focused vector564. The net result is a focusing effect on the negative ion beam. Eachof the force vectors 572, 574, 576, 578 optionally has x and/or y forcevector components resulting in a 3-dimensional focusing of the negativeion beam path. Naturally, the force vectors are illustrative in nature,many electric field lines are encountered, and the focusing effect isobserved at each encounter resulting in integral focusing. The exampleis used to illustrate the focusing effect.

Still referring to FIG. 5, optionally any number of electrodes are used,such as 2, 3, 4, 5, 6, 7, 8, or 9 electrodes, to focus the negative ionbeam path where every other electrode, in a given focusing section, iseither positively or negatively charged. For example, three focusingsections are optionally used. In the first ion focusing section 360, apair of electrodes is used where the first electrode encountered alongthe negative ion beam path is negatively charged and the secondelectrode is positively charged, resulting in focusing of the negativeion beam path. In the second ion focusing section 370, two pairs ofelectrodes are used, where a common positively charged electrode with aconductive mesh running through the negatively ion beam path 319 isused. Thus, in the second ion focusing section 370, the first electrodeencountered along the negative ion beam path is negatively charged andthe second electrode is positively charged, resulting in focusing of thenegative ion beam path. Further, in the second ion focusing section,moving along the negative ion beam path, a second focusing effect isobserved between the second positively charged electrode and a thirdnegatively charged electrode. In this example, a third ion focusingsection is used that again has three electrodes, which acts in thefashion of the second ion focusing section, describe supra.

Referring now to FIG. 6, the central region of the electrodes in the ionbeam focusing system 350 are further described. Referring now to FIG.6A, the central region of the negatively charged ring electrode 510 ispreferably void of conductive material. Referring now to FIGS. 6B-D, thecentral region of positively charged electrode ring 520 preferablycontains conductive paths 372. Preferably, the conductive paths 372 orconductive material within the positively charged electrode ring 520blocks about 1, 2, 5, or 10 percent of the area and more preferablyblocks about 5 percent of the cross-sectional area of the negative ionbeam path 319. Referring now to FIG. 6B, one option is a conductive mesh610. Referring now to FIG. 6C, a second option is a series of conductivelines 620 running substantially in parallel across the positivelycharged electrode ring 520 that surrounds a portion of the negative ionbeam path 319. Referring now to FIG. 6D, a third option is to have afoil 630 or metallic layer cover all of the cross-sectional area of thenegative ion beam path with holes punched through the material, wherethe holes take up about 90-99 percent and more preferably about 95percent of the area of the foil. More generally, the pair of electrodes510, 520 are configured to provide electric field lines that providefocusing force vectors to the negative ion beam 319 when the ions in thenegative ion beam 319 translate through the electric field lines, asdescribed supra.

In an example of a two electrode negative beam ion focusing systemhaving a first cross-sectional diameter, d₁, the negative ions arefocused to a second cross-sectional diameter, d₂, where d₁>d₂.Similarly, in an example of a three electrode negative beam ion focusingsystem having a first ion beam cross-sectional diameter, d₁, thenegative ions are focused using the three electrode system to a thirdnegative ion beam cross-sectional diameter, d₃, where d₁>d₃. For likepotentials on the electrodes, the three electrode system providestighter or stronger focusing compared to the two-electrode system,d₃<d₂.

In the examples provided, supra, of a multi-electrode ion beam focusingsystem, the electrodes are rings. More generally, the electrodes are ofany geometry sufficient to provide electric field lines that providefocusing force vectors to the negative ion beam when the ions in thenegative ion beam 319 translate through the electric field lines, asdescribed supra. For example, one negative ring electrode is optionallyreplaced by a number of negatively charged electrodes, such as about 2,3, 4, 6, 8, 10, or more electrodes placed about the outer region of across-sectional area of the negative ion beam probe. Generally, moreelectrodes are required to converge or diverge a faster or higher energybeam.

In another embodiment, by reversing the polarity of electrodes in theabove example, the negative ion beam is made to diverge. Thus, thenegative ion beam path 319 is optionally focused and/or expanded usingcombinations of electrode pairs. For example, if the electrode havingthe mesh across the negative ion beam path is made negative, then thenegative ion beam path is made to defocus. Hence, combinations ofelectrode pairs are used for focusing and defocusing a negative ion beampath, such as where a first pair includes a positively charged mesh forfocusing and a where a second pair includes a negatively charged meshfor defocusing.

Tandem Accelerator

Referring now to FIG. 7A, the tandem accelerator 390 is furtherdescribed. The tandem accelerator accelerates ions using a series ofelectrodes 710, 711, 712, 713, 714, 715. For example, negative ions,such as H⁻, in the negative ion beam path are accelerated using a seriesof electrodes having progressively higher voltages relative to thevoltage of the extraction electrode 426, or third electrode 426, of thenegative ion beam source 310. For instance, the tandem accelerator 390optionally has electrodes ranging from the 25 kV of the extractionelectrode 426 to about 525 kV near the foil 395 in the tandemaccelerator 390. Upon passing through the foil 395, the negative ion,H⁻, loses two electrons to yield a proton, H⁺, according to equation 1.H⁻→H⁺+2e ⁻  (eq. 1)The proton is further accelerated in the tandem accelerator usingappropriate voltages at a multitude of further electrodes 713, 714, 715.The protons are then injected into the synchrotron 130 as described,supra.

Still referring to FIG. 7, the foil 395 in the tandem accelerator 390 isfurther described. The foil 395 is preferably a very thin carbon film ofabout thirty to two hundred angstroms in thickness. The foil thicknessis designed to both: (1) not block the ion beam and (2) allow thetransfer of electrons yielding protons to form the proton beam path 262.The foil 395 is preferably substantially in contact with a support layer720, such as a support grid. The support layer 720 provides mechanicalstrength to the foil 395 to combine to form a vacuum blocking element725. The foil 395 blocks nitrogen, carbon dioxide, hydrogen, and othergases from passing and thus acts as a vacuum barrier. In one embodiment,the foil 395 is preferably sealed directly or indirectly to the edges ofthe vacuum tube 320 providing for a higher pressure, such as about 10⁻⁵torr, to be maintained on the side of the foil 395 having the negativeion beam path 319 and a lower pressure, such as about 10⁻⁷ torr, to bemaintained on the side of the foil 395 having the proton ion beam path262. Having the foil 395 physically separating the vacuum chamber 320into two pressure regions allows for a vacuum system having fewer and/orsmaller pumps to maintain the lower pressure system in the synchrotron130 as the inlet hydrogen and its residuals are extracted in a separatecontained and isolated space by the first partial vacuum system 330. Thefoil 395 and support layer 720 are preferably attached to the structure750 of the tandem accelerator 390 or vacuum tube 320 to form a pressurebarrier using any mechanical means, such as a metal, plastic, or ceramicring 730 compressed to the walls with an attachment screw 740. Anymechanical means for separating and sealing the two vacuum chamber sideswith the foil 395 are equally applicable to this system. Referring nowto FIG. 7B, the support structure 720 and foil 395 are individuallyviewed in the x-, y-plane. Referring now to FIG. 7C, the foil 395 isillustrated.

Referring now to FIG. 8, another exemplary method of use of the chargedparticle beam system 100. The main controller 110, or one or moresub-controllers, controls one or more of the subsystems to accuratelyand precisely deliver protons to a tumor of a patient. For example, themain controller sends a message to the patient indicating when or how tobreath. The main controller 110 obtains a sensor reading from thepatient interface module, such as a temperature breath sensor or a forcereading indicative of where in a respiration cycle the subject is.Coordinated at a specific and reproducible point in the respirationcycle, the main controller collects an image, such as a portion of abody and/or of a tumor, from the imaging system 170. The main controller110 also obtains position and/or timing information from the patientinterface module 150. The main controller 110 then optionally controlsthe injection system 120 to inject hydrogen gas into a negative ion beamsource 310 and controls timing of extraction of the negative ion fromthe negative ion beam source 310. Optionally, the main controllercontrols ion beam focusing the ion beam focusing lens system 350;acceleration of the proton beam with the tandem accelerator 390; and/orinjection of the proton into the synchrotron 130. The synchrotrontypically contains at least an accelerator system 132 and an extractionsystem 134. The synchrotron preferably contains one or more of: turningmagnets, edge focusing magnets, magnetic field concentration magnets,winding and correction coils, and flat magnetic field incident surfaces,some of which contain elements under control by the main controller 110.The main controller preferably controls the proton beam within theaccelerator system, such as by controlling speed, trajectory, and/ortiming of the proton beam. The main controller then controls extractionof a proton beam from the accelerator through the extraction system 134.For example, the controller controls timing, energy, and/or intensity ofthe extracted beam. The main controller 110 also preferably controlstargeting of the proton beam through the targeting/delivery system 140to the patient interface module 150. One or more components of thepatient interface module 150 are preferably controlled by the maincontroller 110, such as vertical position of the patient, rotationalposition of the patient, and patient chairpositioning/stabilization/immobilization/control elements. Further,display elements of the display system 160 are preferably controlled viathe main controller 110. Displays, such as display screens, aretypically provided to one or more operators and/or to one or morepatients. In one embodiment, the main controller 110 times the deliveryof the proton beam from all systems, such that protons are delivered inan optimal therapeutic manner to the tumor of the patient.

Synchrotron

Herein, the term synchrotron is used to refer to a system maintainingthe charged particle beam in a circulating path. Further, the chargedparticle beam is referred to herein as circulating along a circulatingpath about a central point of the synchrotron. The circulating path isalternatively referred to as an orbiting path; however, the orbitingpath does not refer a perfect circle or ellipse, rather it refers tocycling of the protons around a central point or region 280.

Circulating System

Referring now to FIG. 9, the synchrotron 130 preferably comprises acombination of straight sections 910 and ion beam turning sections 920.Hence, the circulating path of the protons is not circular in asynchrotron, but is rather a polygon with rounded corners.

In one illustrative embodiment, the synchrotron 130, which as alsoreferred to as an accelerator system, has four straight sections andfour turning sections. Examples of straight sections 910 include the:inflector 240, accelerator 270, extraction system 290, and deflector292. Along with the four straight sections are four ion beam turningsections 920, which are also referred to as magnet sections or turningsections. Turning sections are further described, infra.

Referring still to FIG. 9, an exemplary synchrotron is illustrated. Inthis example, protons delivered along the initial proton beam path 262are inflected into the circulating beam path with the inflector 240 andafter acceleration are extracted via a deflector 292 to the beamtransport path 268. In this example, the synchrotron 130 comprises fourstraight sections 910 and four bending or turning sections 920 whereeach of the four turning sections use one or more magnets to turn theproton beam about ninety degrees. As is further described, infra, theability to closely space the turning sections and efficiently turn theproton beam results in shorter straight sections. Shorter straightsections allows for a synchrotron design without the use of focusingquadrupoles in the circulating beam path of the synchrotron. The removalof the focusing quadrupoles from the circulating proton beam pathresults in a more compact design. In this example, the illustratedsynchrotron has about a five meter diameter versus eight meter andlarger cross-sectional diameters for systems using a quadrupole focusingmagnet in the circulating proton beam path.

Referring now to FIG. 10, additional description of the first bending orturning section 920 is provided. Each of the turning sections preferablycomprise multiple magnets, such as about 2, 4, 6, 8, 10, or 12 magnets.In this example, four turning magnets 1010, 1020, 1030, 1040 in thefirst turning section 920 are used to illustrate key principles, whichare the same regardless of the number of magnets in a turning section920. The turning magnets 1010, 1020, 1030, 1040 are particular types ofmain bending or circulating magnets 250.

In physics, the Lorentz force is the force on a point charge due toelectromagnetic fields. The Lorentz force is given by equation 2 interms of magnetic fields with the election field terms not included.F=q(v×B)  (eq. 2)

In equation 2, F is the force in newtons; q is the electric charge incoulombs; B is the magnetic field in Teslas; and v is the instantaneousvelocity of the particles in meters per second.

Referring now to FIG. 11, an example of a single magnet bending orturning section 1010 is expanded. The turning section includes a gap1110 through which protons circulate. The gap 1110 is preferably a flatgap, allowing for a magnetic field across the gap 1110 that is moreuniform, even, and intense. A magnetic field enters the gap 1110 througha magnetic field incident surface and exits the gap 1110 through amagnetic field exiting surface 1280. The gap 1110 runs in a vacuum tubebetween two magnet halves. The gap 1110 is controlled by at least twoparameters: (1) the gap 1110 is kept as large as possible to minimizeloss of protons and (2) the gap 1110 is kept as small as possible tominimize magnet sizes and the associated size and power requirements ofthe magnet power supplies. The flat nature of the gap 1110 allows for acompressed and more uniform magnetic field across the gap 1110. Oneexample of a gap dimension is to accommodate a vertical proton beam sizeof about two centimeters with a horizontal beam size of about five tosix centimeters.

As described, supra, a larger gap size requires a larger power supply.For instance, if the gap 1110 size doubles in vertical size, then thepower supply requirements increase by about a factor of four. Theflatness of the gap 1110 is also important. For example, the flat natureof the gap 1110 allows for an increase in energy of the extractedprotons from about 250 to about 330 MeV. More particularly, if the gap1110 has an extremely flat surface, then the limits of a magnetic fieldof an iron magnet are reachable. An exemplary precision of the flatsurface of the gap 1110 is a polish of less than about five microns andpreferably with a polish of about one to three microns. Unevenness inthe surface results in imperfections in the applied magnetic field. Thepolished flat surface spreads unevenness of the applied magnetic field.

Still referring to FIG. 11, the charged particle beam moves through thegap 1110 with an instantaneous velocity, v. A first magnetic coil 1120and a second magnetic coil 1130 run above and below the gap 1110,respectively. Current running through the coils 1120, 1130 results in amagnetic field, B, running through the single magnet turning section1010. In this example, the magnetic field, B, runs upward, which resultsin a force, F, pushing the charged particle beam inward toward a centralpoint of the synchrotron, which turns the charged particle beam in anarc.

Still referring to FIG. 11, a portion of an optional second magnetbending or turning section 1020 is illustrated. The coils 1120, 1130typically have return elements 1140, 1150 or turns at the end of onemagnet, such as at the end of the first magnet turning section 1010. Theturns 1140, 1150 take space. The space reduces the percentage of thepath about one orbit of the synchrotron that is covered by the turningmagnets. This leads to portions of the circulating path where theprotons are not turned and/or focused and allows for portions of thecirculating path where the proton path defocuses. Thus, the spaceresults in a larger synchrotron. Therefore, the space between magnetturning sections 1160 is preferably minimized. The second turning magnetis used to illustrate that the coils 1120, 1130 optionally run along aplurality of magnets, such as 2, 3, 4, 5, 6, or more magnets. Coils1120, 1130 running across multiple turning section magnets allows fortwo turning section magnets to be spatially positioned closer to eachother due to the removal of the steric constraint of the turns, whichreduces and/or minimizes the space 1160 between two turning sectionmagnets.

Referring now to FIGS. 12 and 13, two illustrative 90 degree rotatedcross-sections of single magnet bending or turning sections 1010 arepresented. The magnet assembly has a first magnet 1210 and a secondmagnet 1220. A magnetic field induced by coils, described infra, runsbetween the first magnet 1210 to the second magnet 1220 across the gap1110. Return magnetic fields run through a first yoke 1212 and secondyoke 1222. The combined cross-section area of the return yokes roughlyapproximates the cross-sectional area of the first magnet 1210 or secondmagnet 1220. The charged particles run through the vacuum tube in thegap 1110. As illustrated, protons run into FIG. 12 through the gap 1110and the magnetic field, illustrated as vector B, applies a force F tothe protons pushing the protons towards the center of the synchrotron,which is off page to the right in FIG. 12. The magnetic field is createdusing windings. A first wire makes a first winding coil 1250 and asecond wire makes up a second winding coil 1260. Isolating orconcentrating gaps 1230, 1240, such as air gaps, isolate the iron basedyokes from the gap 1110. The gap 1110 is approximately flat to yield auniform magnetic field across the gap 1110, as described supra.

Still referring to FIG. 13, the ends of a single bending or turningmagnet are preferably beveled. Nearly perpendicular or right angle edgesof a turning magnet 1010 are represented by dashed lines 1374, 1384. Thedashed lines 1374, 1384 intersect at a point 1390 beyond the center ofthe synchrotron 280. Preferably, the edge of the turning magnet isbeveled at angles alpha, α, and beta, β, which are angles formed by afirst line 1372, 1382 going from an edge of the turning magnet 1010 andthe center 280 and a second line 1374, 1384 going from the same edge ofthe turning magnet and the intersecting point 1390. The angle alpha isused to describe the effect and the description of angle alpha appliesto angle beta, but angle alpha is optionally different from angle beta.The angle alpha provides an edge focusing effect. Beveling the edge ofthe turning magnet 1010 at angle alpha focuses the proton beam.

Multiple turning magnets provide multiple magnet edges that each haveedge focusing effects in the synchrotron 130. If only one turning magnetis used, then the beam is only focused once for angle alpha or twice forangle alpha and angle beta. However, by using smaller turning magnets,more turning magnets fit into the turning sections 920 of thesynchrotron 130. For example, if four magnets are used in a turningsection 920 of the synchrotron, then for a single turning section thereare eight possible edge focusing effect surfaces, two edges per magnet.The eight focusing surfaces yield a smaller cross-sectional beam size,which allows the use of a smaller gap.

The use of multiple edge focusing effects in the turning magnets resultsin not only a smaller gap 1110, but also the use of smaller magnets andsmaller power supplies. For a synchrotron 130 having four turningsections 920 where each turning sections has four turning magnets andeach turning magnet has two focusing edges, a total of thirty-twofocusing edges exist for each orbit of the protons in the circulatingpath of the synchrotron 130. Similarly, if 2, 6, or 8 magnets are usedin a given turning section, or if 2, 3, 5, or 6 turning sections areused, then the number of edge focusing surfaces expands or contractsaccording to equation 3.

$\begin{matrix}{{T\; F\; E} = {N\; T\; S*\frac{M}{N\; T\; S}*\frac{F\; E}{M}}} & \left( {{eq}.\mspace{14mu} 3} \right)\end{matrix}$where TFE is the number of total focusing edges, NTS is the number ofturning sections, M is the number of magnets, and FE is the number offocusing edges. Naturally, not all magnets are necessarily beveled andsome magnets are optionally beveled on only one edge.

The inventors have determined that multiple smaller magnets havebenefits over fewer larger magnets. For example, the use of 16 smallmagnets yields 32 focusing edges whereas the use of 4 larger magnetsyields only 8 focusing edges. The use of a synchrotron having morefocusing edges results in a circulating path of the synchrotron builtwithout the use of focusing quadrupole magnets. All prior artsynchrotrons use quadrupoles in the circulating path of the synchrotron.Further, the use of quadrupoles in the circulating path necessitatesadditional straight sections in the circulating path of the synchrotron.Thus, the use of quadrupoles in the circulating path of a synchrotronresults in synchrotrons having larger diameters, larger circulating beampathlengths, and/or larger circumferences.

In various embodiments of the system described herein, the synchrotronhas any combination of:

-   -   at least 4 and preferably 6, 8, 10, or more edge focusing edges        per 90 degrees of turn of the charged particle beam in a        synchrotron having four turning sections;    -   at least about 16 and preferably about 24, 32, or more edge        focusing edges per orbit of the charged particle beam in the        synchrotron;    -   only 4 turning sections where each of the turning sections        includes at least 4 and preferably 8 edge focusing edges;    -   an equal number of straight sections and turning sections;    -   exactly 4 turning sections;    -   at least 4 focusing edges per turning section;    -   no quadrupoles in the circulating path of the synchrotron;    -   a rounded corner rectangular polygon configuration;    -   a circumference of less than 60 meters;    -   a circumference of less than 60 meters and 32 edge focusing        surfaces; and/or    -   any of about 8, 16, 24, or 32 non-quadrupole magnets per        circulating path of the synchrotron, where the non-quadrupole        magnets include edge focusing edges.        Flat Gap Surface

While the gap surface is described in terms of the first turning magnet1010, the discussion applies to each of the turning magnets in thesynchrotron. Similarly, while the gap 1110 surface is described in termsof the magnetic field incident surface 670, the discussion additionallyoptionally applies to the magnetic field exiting surface 680.

Referring again to FIG. 12, the incident magnetic field surface 1270 ofthe first magnet 1210 is further described. FIG. 12 is not to scale andis illustrative in nature. Local imperfections or unevenness in qualityof the finish of the incident surface 1270 results in inhomogeneities orimperfections in the magnetic field applied to the gap 1110. Themagnetic field incident surface 1270 and/or exiting surface 1280 of thefirst magnet 1210 is preferably about flat, such as to within about azero to three micron finish polish or less preferably to about a tenmicron finish polish. By being very flat, the polished surface spreadsthe unevenness of the applied magnetic field across the gap 1110. Thevery flat surface, such as about 0, 1, 2, 4, 6, 8, 10, 15, or 20 micronfinish, allows for a smaller gap size, a smaller applied magnetic field,smaller power supplies, and tighter control of the proton beamcross-sectional area.

Referring now to FIG. 14, additional optional magnet elements, of themagnet cross-section illustratively represented in FIG. 12, aredescribed. The first magnet 1210 preferably contains an initialcross-sectional distance 1410 of the iron based core. The contours ofthe magnetic field are shaped by the magnets 1210, 1220 and the yokes1212, 1222. The iron based core tapers to a second cross-sectionaldistance 1420. The shape of the magnetic field vector 1440 isillustrative only. The magnetic field in the magnet preferentially staysin the iron based core as opposed to the gaps 1230, 1240. As thecross-sectional distance decreases from the initial cross-sectionaldistance 1410 to the final cross-sectional distance 1420, the magneticfield concentrates. The change in shape of the magnet from the longerdistance 1410 to the smaller distance 1420 acts as an amplifier. Theconcentration of the magnetic field is illustrated by representing aninitial density of magnetic field vectors 1430 in the initialcross-section 1410 to a concentrated density of magnetic field vectors1440 in the final cross-section 1420. The concentration of the magneticfield due to the geometry of the turning magnets results in fewerwinding coils 1250, 1260 being required and also a smaller power supplyto the coils being required.

In one example, the initial cross-section distance 1410 is about fifteencentimeters and the final cross-section distance 1420 is about tencentimeters. Using the provided numbers, the concentration of themagnetic field is about 15/10 or 1.5 times at the incident surface 1270of the gap 1110, though the relationship is not linear. The taper 1460has a slope, such as about 20, 40, or 60 degrees. The concentration ofthe magnetic field, such as by 1.5 times, leads to a correspondingdecrease in power consumption requirements to the magnets.

Referring now to FIG. 15, an additional example of geometry of themagnet used to concentrate the magnetic field is illustrated. Asillustrated in FIG. 14, the first magnet 1210 preferably contains aninitial cross-sectional distance 1410 of the iron based core. Thecontours of the magnetic field are shaped by the magnets 1210, 1220 andthe yokes 1212, 1222. In this example, the core tapers to a secondcross-sectional distance 1420 with a smaller angle theta, θ. Asdescribed, supra, the magnetic field in the magnet preferentially staysin the iron based core as opposed to the gaps 1230, 1240. As thecross-sectional distance decreases from the initial cross-sectionaldistance 1410 to the final cross-sectional distance 1420, the magneticfield concentrates. The smaller angle, theta, results in a greateramplification of the magnetic field in going from the longer distance1410 to the smaller distance 1420. The concentration of the magneticfield is illustrated by representing an initial density of magneticfield vectors 1430 in the initial cross-section 1410 to a concentrateddensity of magnetic field vectors 1440 in the final cross-section 1420.The concentration of the magnetic field due to the geometry of theturning magnets results in fewer winding coils 1250, 1260 being requiredand also a smaller power supply to the winding coils 1250, 1260 beingrequired.

Still referring to FIG. 15, optional correction coils 1510, 1520 areillustrated that are used to correct the strength of one or more turningmagnets. The correction coils 1520, 1530 supplement the winding coils1250, 1260. The correction coils 1510, 1520 have correction coil powersupplies that are separate from winding coil power supplies used withthe winding coils 1250, 1260. The correction coil power suppliestypically operate at a fraction of the power required compared to thewinding coil power supplies, such as about 1, 2, 3, 5, 7, or 10 percentof the power and more preferably about 1 or 2 percent of the power usedwith the winding coils 1250, 1260. The smaller operating power appliedto the correction coils 1510, 1520 allows for more accurate and/orprecise control of the correction coils. The correction coils 1510, 1520are used to adjust for imperfection in the turning magnets 1010, 1020.Optionally, separate correction coils are used for each turning magnetallowing individual tuning of the magnetic field for each turningmagnet, which eases quality requirements in the manufacture of eachturning magnet.

Referring now to FIG. 16, an example of winding coils and correctioncoils about a plurality of turning magnets 1610, 1620 in an ion beamturning section 920 is illustrated. As illustrated, the winding coilspreferably cover r1, 2, or 4 turning magnets. One or more high precisionmagnetic field sensors 1830 are placed into the synchrotron and are usedto measure the magnetic field at or near the proton beam path. Forexample, the magnetic sensors are optionally placed between turningmagnets and/or within a turning magnet, such as at or near the gap 1110or at or near the magnet core or yoke. The sensors are part of afeedback system to the correction coils, which is optionally run by themain controller. Thus, the system preferably stabilizes the magneticfield in the synchrotron elements rather than stabilizing the currentapplied to the magnets. Stabilization of the magnetic field allows thesynchrotron to come to a new energy level quickly. This allows thesystem to be controlled to an operator or algorithm selected energylevel with each pulse of the synchrotron and/or with each breath of thepatient.

The winding and/or correction coils correct 1, 2, 3, or 4 turningmagnets, and preferably correct a magnetic field generated by twoturning magnets. In the illustrated example, a correction coil 1640winds around a single turning magnet. In a second example, a correctioncoil 1620 winds around two or more magnets. A winding or correction coilcovering multiple magnets reduces space between magnets as fewer windingor correction coil ends are required, which occupy space.

Referring now to FIG. 17A and FIG. 17B, the accelerator system 270, suchas a radio-frequency (RF) accelerator system, is further described. Theaccelerator includes a series of coils 1710-1719, such as iron orferrite coils, each circumferentially enclosing the vacuum system 320through which the proton beam 264 passes in the synchrotron 130.Referring now to FIG. 17B, the first coil 1710 is further described. Aloop of standard wire 1730 completes at least one turn about the firstcoil 1710. The loop attaches to a microcircuit 1720. Referring again toFIG. 17A, an RF synthesizer 1740, which is preferably connected to themain controller 110, provides a low voltage RF signal that issynchronized to the period of circulation of protons in the proton beampath 264. The RF synthesizer 1740, microcircuit 1720, loop 1730, andcoil 1710 combine to provide an accelerating voltage to the protons inthe proton beam path 264. For example, the RF synthesizer 1740 sends asignal to the microcircuit 1720, which amplifies the low voltage RFsignal and yields an acceleration voltage, such as about 10 volts. Theactual acceleration voltage for a single microcircuit/loop/coilcombination is about 5, 10, 15, or 20 volts, but is preferably about 10volts. Preferably, the RF-amplifier microcircuit and accelerating coilare integrated.

Still referring to FIG. 17A, the integrated RF-amplifier microcircuitand accelerating coil presented in FIG. 17B is repeated, as illustratedas the set of coils 1711-1719 surrounding the vacuum tube 320. Forexample, the RF-synthesizer 1740, under main controller 130 direction,sends an RF-signal to the microcircuits 1720-1729 connected to coils1710-1719, respectively. Each of the microcircuit/loop/coil combinationsgenerates a proton accelerating voltage, such as about 10 volts each.Hence, a set of five coil combinations generates about 50 volts forproton acceleration. Preferably about 5 to 20 microcircuit/loop/coilcombinations are used and more preferably about 9 or 10microcircuit/loop/coil combinations are used in the accelerator system270.

As a further clarifying example, the RF synthesizer 1740 sends anRF-signal, with a period equal to a period of circulation of a protonabout the synchrotron 130, to a set of ten microcircuit/loop/coilcombinations, which results in about 100 volts for acceleration of theprotons in the proton beam path 264. The 100 volts is generated at arange of frequencies, such as at about 1 MHz for a low energy protonbeam to about 15 MHz for a high energy proton beam. The RF-signal isoptionally set at an integer multiple of a period of circulation of theproton about the synchrotron circulating path. Each of themicrocircuit/loop/coil combinations are optionally independentlycontrolled in terms of acceleration voltage and frequency.

Integration of the RF-amplifier microcircuit and accelerating coil, ineach microcircuit/loop/coil combination, results in three considerableadvantages. First, for synchrotrons, the prior art does not usemicrocircuits integrated with the accelerating coils but rather uses aset of long cables to provide power to a corresponding set of coils. Thelong cables have an impedance/resistance, which is problematic for highfrequency RF control. As a result, the prior art system is not operableat high frequencies, such as above about 10 MHz. The integratedRF-amplifier microcircuit/accelerating coil system is operable at aboveabout 10 MHz and even 15 MHz where the impedance and/or resistance ofthe long cables in the prior art systems results in poor control orfailure in proton acceleration. Second, the long cable system, operatingat lower frequencies, costs about $50,000 and the integratedmicrocircuit system costs about $1000, which is 50 times less expensive.Third, the microcircuit/loop/coil combinations in conjunction with theRF-amplifier system results in a compact low power consumption designallowing production and use of a proton cancer therapy system in a smallspace, as described supra, and in a cost effective manner.

Referring now to FIG. 18, an example is used to clarify the magneticfield control using a feedback loop 1800 to change delivery times and/orperiods of proton pulse delivery. In one case, a respiratory sensor 1810senses the respiration cycle of the subject. The respiratory sensorsends the information to an algorithm in a magnetic field controller1820, typically via the patient interface module 150 and/or via the maincontroller 110 or a subcomponent thereof. The algorithm predicts and/ormeasures when the subject is at a particular point in the respirationcycle, such as at the bottom of a breath. Magnetic field sensors 1830are used as input to the magnetic field controller, which controls amagnet power supply 1840 for a given magnetic field 1850, such as withina first turning magnet 1010 of a synchrotron 130. The control feedbackloop is thus used to dial the synchrotron to a selected energy level anddeliver protons with the desired energy at a selected point in time,such as at the bottom of the breath. More particularly, the maincontroller injects protons into the synchrotron and accelerates theprotons in a manner that combined with extraction delivers the protonsto the tumor at a selected point in the respiration cycle. Intensity ofthe proton beam is also selectable and controllable by the maincontroller at this stage. The feedback control to the correction coilsallows rapid selection of energy levels of the synchrotron that are tiedto the patient's respiration cycle. This system is in stark contrast toa system where the current is stabilized and the synchrotron deliverpulses with a period, such as 10 or 20 cycles per second with a fixedperiod. Optionally, the feedback or the magnetic field design coupledwith the correction coils allows for the extraction cycle to match thevarying respiratory rate of the patient.

Traditional extraction systems do not allow this control as magnets havememories in terms of both magnitude and amplitude of a sine wave. Hence,in a traditional system, in order to change frequency, slow changes incurrent must be used. However, with the use of the feedback loop usingthe magnetic field sensors, the frequency and energy level of thesynchrotron are rapidly adjustable. Further aiding this process is theuse of a novel extraction system that allows for acceleration of theprotons during the extraction process, described infra.

Referring again to FIG. 16, an example of a winding coil 1630 thatcovers two turning magnets 1010, 1020 is provided. Optionally, a firstwinding coil 1640 covers two magnets and a second winding coil, notillustrated, covers another two magnets. As described, supra, thissystem reduces space between turning section allowing more magneticfield to be applied per radian of turn. A first correction coil 1610 isillustrated that is used to correct the magnetic field for the firstturning magnet 1010. A second correction coil 1620 is illustrated thatis used to correct the magnetic field for a winding coil 1630 about twoturning magnets. Individual correction coils for each turning magnet arepreferred and individual correction coils yield the most precise and/oraccurate magnetic field in each turning section. Particularly, theindividual correction coil 1610 is used to compensate for imperfectionsin the individual magnet of a given turning section. Hence, with aseries of magnetic field sensors, corresponding magnetic fields areindividually adjustable in a series of feedback loops, via a magneticfield monitoring system, as an independent coil is used for each turningsection. Alternatively, a multiple magnet correction coil is used tocorrect the magnetic field for a plurality of turning section magnets.

Proton Beam Extraction

Referring now to FIG. 19, an exemplary proton extraction process fromthe synchrotron 130 is illustrated. For clarity, FIG. 19 removeselements represented in FIG. 2, such as the turning magnets, whichallows for greater clarity of presentation of the proton beam path as afunction of time. Generally, protons are extracted from the synchrotron130 by slowing the protons. As described, supra, the protons wereinitially accelerated in a circulating path 264, which is maintainedwith a plurality of main bending magnets 250. The circulating path isreferred to herein as an original central beamline 264. The protonsrepeatedly cycle around a central point in the synchrotron 280. Theproton path traverses through a radio frequency (RF) cavity system 1910.To initiate extraction, an RF field is applied across a first blade 1912and a second blade 1914, in the RF cavity system 1910. The first blade1912 and second blade 1914 are referred to herein as a first pair ofblades.

In the proton extraction process, an RF voltage is applied across thefirst pair of blades, where the first blade 1912 of the first pair ofblades is on one side of the circulating proton beam path 264 and thesecond blade 1914 of the first pair of blades is on an opposite side ofthe circulating proton beam path 264. The applied RF field appliesenergy to the circulating charged-particle beam. The applied RF fieldalters the orbiting or circulating beam path slightly of the protonsfrom the original central beamline 264 to an altered circulating beampath 265. Upon a second pass of the protons through the RF cavitysystem, the RF field further moves the protons off of the originalproton beamline 264. For example, if the original beamline is consideredas a circular path, then the altered beamline is slightly elliptical.The applied RF field is timed to apply outward or inward movement to agiven band of protons circulating in the synchrotron accelerator. Eachorbit of the protons is slightly more off axis compared to the originalcirculating beam path 264. Successive passes of the protons through theRF cavity system are forced further and further from the originalcentral beamline 264 by altering the direction and/or intensity of theRF field with each successive pass of the proton beam through the RFfield.

The RF voltage is frequency modulated at a frequency about equal to theperiod of one proton cycling around the synchrotron for one revolutionor at a frequency than is an integral multiplier of the period of oneproton cycling about the synchrotron. The applied RF frequency modulatedvoltage excites a betatron oscillation. For example, the oscillation isa sine wave motion of the protons. The process of timing the RF field toa given proton beam within the RF cavity system is repeated thousands oftimes with each successive pass of the protons being moved approximatelyone micrometer further off of the original central beamline 264. Forclarity, the approximately 1000 changing beam paths with each successivepath of a given band of protons through the RF field are illustrated asthe altered beam path 265.

With a sufficient sine wave betatron amplitude, the altered circulatingbeam path 265 touches or traverses a material 1930, such as a foil or asheet of foil. The foil is preferably a lightweight material, such asberyllium, a lithium hydride, a carbon sheet, or a material having lownuclear charge components. Herein, a material of low nuclear charge is amaterial composed of atoms consisting essentially of atoms having six orfewer protons. The foil is preferably about 10 to 150 microns thick, ismore preferably about 30 to 100 microns thick, and is still morepreferably about 40 to 60 microns thick. In one example, the foil isberyllium with a thickness of about 50 microns. When the protonstraverse through the foil, energy of the protons is lost and the speedof the protons is reduced. Typically, a current is also generated,described infra. Protons moving at a slower speed travel in thesynchrotron with a reduced radius of curvature 266 compared to eitherthe original central beamline 264 or the altered circulating path 265.The reduced radius of curvature 266 path is also referred to herein as apath having a smaller diameter of trajectory or a path having protonswith reduced energy. The reduced radius of curvature 266 is typicallyabout two millimeters less than a radius of curvature of the last passof the protons along the altered proton beam path 265.

The thickness of the material 1930 is optionally adjusted to created achange in the radius of curvature, such as about ½, 1, 2, 3, or 4 mmless than the last pass of the protons 265 or original radius ofcurvature 264. Protons moving with the smaller radius of curvaturetravel between a second pair of blades. In one case, the second pair ofblades is physically distinct and/or is separated from the first pair ofblades. In a second case, one of the first pair of blades is also amember of the second pair of blades. For example, the second pair ofblades is the second blade 1914 and a third blade 1916 in the RF cavitysystem 1910. A high voltage DC signal, such as about 1 to 5 kV, is thenapplied across the second pair of blades, which directs the protons outof the synchrotron through an extraction magnet 292, such as a Lambersonextraction magnet, into a transport path 268.

Control of acceleration of the charged particle beam path in thesynchrotron with the accelerator and/or applied fields of the turningmagnets in combination with the above described extraction system allowsfor control of the intensity of the extracted proton beam, whereintensity is a proton flux per unit time or the number of protonsextracted as a function of time. For example, when a current is measuredbeyond a threshold, the RF field modulation in the RF cavity system isterminated or reinitiated to establish a subsequent cycle of proton beamextraction. This process is repeated to yield many cycles of proton beamextraction from the synchrotron accelerator.

Because the extraction system does not depend on any change in magneticfield properties, it allows the synchrotron to continue to operate inacceleration or deceleration mode during the extraction process. Stateddifferently, the extraction process does not interfere with synchrotronacceleration. In stark contrast, traditional extraction systemsintroduce a new magnetic field, such as via a hexapole, during theextraction process. More particularly, traditional synchrotrons have amagnet, such as a hexapole magnet, that is off during an accelerationstage. During the extraction phase, the hexapole magnetic field isintroduced to the circulating path of the synchrotron. The introductionof the magnetic field necessitates two distinct modes, an accelerationmode and an extraction mode, which are mutually exclusive in time. Theherein described system allows for acceleration and/or deceleration ofthe proton during the extraction step without the use of a newlyintroduced magnetic field, such as by a hexapole magnet.

Charged Particle Beam Intensity Control

Control of applied field, such as a radio-frequency (RF) field,frequency and magnitude in the RF cavity system 1910 allows forintensity control of the extracted proton beam, where intensity isextracted proton flux per unit time or the number of protons extractedas a function of time.

Referring still to FIG. 19, when protons in the proton beam hit thematerial 1930 electrons are given off resulting in a current. Theresulting current is converted to a voltage and is used as part of a ionbeam intensity monitoring system or as part of an ion beam feedback loopfor controlling beam intensity. The voltage is optionally measured andsent to the main controller 110 or to a controller subsystem 1940. Moreparticularly, when protons in the charged particle beam path passthrough the material 1930, some of the protons lose a small fraction oftheir energy, such as about one-tenth of a percent, which results in asecondary electron. That is, protons in the charged particle beam pushsome electrons when passing through material 1930 giving the electronsenough energy to cause secondary emission. The resulting electron flowresults in a current or signal that is proportional to the number ofprotons going through the target material 1930. The resulting current ispreferably converted to voltage and amplified. The resulting signal isreferred to as a measured intensity signal.

The amplified signal or measured intensity signal resulting from theprotons passing through the material 1930 is preferably used incontrolling the intensity of the extracted protons. For example, themeasured intensity signal is compared to a goal signal, which ispredetermined in an irradiation of the tumor plan. The differencebetween the measured intensity signal and the planned for goal signal iscalculated. The difference is used as a control to the RF generator.Hence, the measured flow of current resulting from the protons passingthrough the material 1930 is used as a control in the RF generator toincrease or decrease the number of protons undergoing betatronoscillation and striking the material 1930. Hence, the voltagedetermined off of the material 1930 is used as a measure of the orbitalpath and is used as a feedback control to control the RF cavity system.Alternatively, the measured intensity signal is not used in the feedbackcontrol and is just used as a monitor of the intensity of the extractedprotons.

As described, supra, the photons striking the material 1930 is a step inthe extraction of the protons from the synchrotron 130. Hence, themeasured intensity signal is used to change the number of protons perunit time being extracted, which is referred to as intensity of theproton beam. The intensity of the proton beam is thus under algorithmcontrol. Further, the intensity of the proton beam is controlledseparately from the velocity of the protons in the synchrotron 130.Hence, intensity of the protons extracted and the energy of the protonsextracted are independently variable.

For example, protons initially move at an equilibrium trajectory in thesynchrotron 130. An RF field is used to excite the protons into abetatron oscillation. In one case, the frequency of the protons orbit isabout 10 MHz. In one example, in about one millisecond or after about10,000 orbits, the first protons hit an outer edge of the targetmaterial 130. The specific frequency is dependent upon the period of theorbit. Upon hitting the material 130, the protons push electrons throughthe foil to produce a current. The current is converted to voltage andamplified to yield a measured intensity signal. The measured intensitysignal is used as a feedback input to control the applied RF magnitude,RF frequency, or RF field. Preferably, the measured intensity signal iscompared to a target signal and a measure of the difference between themeasured intensity signal and target signal is used to adjust theapplied RF field in the RF cavity system 1910 in the extraction systemto control the intensity of the protons in the extraction step. Statedagain, the signal resulting from the protons striking and/or passingthrough the material 130 is used as an input in RF field modulation. Anincrease in the magnitude of the RF modulation results in protonshitting the foil or material 130 sooner. By increasing the RF, moreprotons are pushed into the foil, which results in an increasedintensity, or more protons per unit time, of protons extracted from thesynchrotron 130.

In another example, a detector external to the synchrotron 130 is usedto determine the flux of protons extracted from the synchrotron and asignal from the external detector is used to alter the RF field or RFmodulation in the RF cavity system 1910. Here the external detectorgenerates an external signal, which is used in a manner similar to themeasured intensity signal, described in the preceding paragraphs.

In yet another example, when a current from material 130 resulting fromprotons passing through or hitting material is measured beyond athreshold, the RF field modulation in the RF cavity system is terminatedor reinitiated to establish a subsequent cycle of proton beamextraction. This process is repeated to yield many cycles of proton beamextraction from the synchrotron accelerator.

In still yet another embodiment, intensity modulation of the extractedproton beam is controlled by the main controller 110. The maincontroller 110 optionally and/or additionally controls timing ofextraction of the charged particle beam and energy of the extractedproton beam.

The benefits of the system include a multi-dimensional scanning system.Particularly, the system allows independence in: (1) energy of theprotons extracted and (2) intensity of the protons extracted. That is,energy of the protons extracted is controlled by an energy controlsystem and an intensity control system controls the intensity of theextracted protons. The energy control system and intensity controlsystem are optionally independently controlled. Preferably, the maincontroller 110 controls the energy control system and the maincontroller simultaneously controls the intensity control system to yieldan extracted proton beam with controlled energy and controlled intensitywhere the controlled energy and controlled intensity are independentlyvariable. Thus the irradiation spot hitting the tumor is underindependent control of:

-   -   time;    -   energy;    -   intensity;    -   x-axis position, where the x-axis represents horizontal movement        of the proton beam relative to the patient, and    -   y-axis position, where the y-axis represents vertical movement        of the proton beam relative to the patient.

In addition, the patient is optionally independently translated and/orrotated relative to a translational axis of the proton beam at the sametime.

Referring now to FIGS. 20 A and B, a proton beam position verificationsystem 2000 is described. A nozzle 2010 provides an outlet for thesecond reduced pressure vacuum system initiating at the foil 395 of thetandem accelerator 390 and running through the synchrotron 130 to anozzle foil 2020 covering the end of the nozzle 2010. The nozzle expandsin x-, y-cross-sectional area along the z-axis of the proton beam path268 to allow the proton beam 268 to be scanned along the x- and y-axesby the vertical control element 142 and horizontal control element 144,respectively. The nozzle foil 2020 is preferably mechanically supportedby the outer edges of an exit port of the nozzle 2010. An example of anozzle foil 2020 is a sheet of about 0.1 inch thick aluminum foil.Generally, the nozzle foil separates atmosphere pressures on the patientside of the nozzle foil 2020 from the low pressure region, such as about10⁻⁵ to 10⁻⁷ torr region, on the synchrotron 130 side of the nozzle foil2020. The low pressure region is maintained to reduce scattering of theproton beam 264, 268.

Still referring to FIG. 20, the proton beam verification system 2000 isa system that allows for monitoring of the actual proton beam position268, 269 in real-time without destruction of the proton beam. The protonbeam verification system 2000 preferably includes a proton beam positionverification layer 2030, which is also referred to herein as a coating,luminescent, fluorescent, phosphorescent, radiance, or viewing layer.The verification layer or coating layer 2030 is preferably a coating orthin layer substantially in contact with an inside surface of the nozzlefoil 2020, where the inside surface is on the synchrotron side of thenozzle foil 2020. Less preferably, the verification layer or coatinglayer 2030 is substantially in contact with an outer surface of thenozzle foil 2020, where the outer surface is on the patient treatmentside of the nozzle foil 2020. Preferably, the nozzle foil 2020 providesa substrate surface for coating by the coating layer. Optionally, abinding layer is located between the coating layer 2030 and the nozzlefoil 2020. Optionally a separate coating layer support element, on whichthe coating 2030 is mounted, is placed anywhere in the proton beam path268.

Referring now to FIG. 20B, the coating 2030 yields a measurablespectroscopic response, spatially viewable by the detector 2040, as aresult of transmission by the proton beam 268. The coating 2030 ispreferably a phosphor, but is optionally any material that is viewableor imaged by a detector where the material changes spectroscopically asa result of the proton beam path 268 hitting or transmitting through thecoating 2030. A detector or camera 2040 views the coating layer 2030 anddetermines the current position of the proton beam 269 by thespectroscopic differences resulting from protons passing through thecoating layer. For example, the camera 2040 views the coating surface2030 as the proton beam 268 is being scanned by the horizontal 144 andvertical 142 beam position control elements during treatment of thetumor 2120. The camera 2040 views the current position of the protonbeam 269 as measured by spectroscopic response. The coating layer 2030is preferably a phosphor or luminescent material that glows or emitsphotons for a short period of time, such as less than 5 seconds for a50% intensity, as a result of excitation by the proton beam 268.Optionally, a plurality of cameras or detectors 2040 are used, whereeach detector views all or a portion of the coating layer 2030. Forexample, two detectors 2040 are used where a first detector views afirst half of the coating layer and the second detector views a secondhalf of the coating layer. Preferably, at least a portion of thedetector 2040 is mounted into the nozzle 2010 to view the proton beamposition after passing through the first axis and second axiscontrollers 142, 144. Preferably, the coating layer 2030 is positionedin the proton beam path 268 in a position prior to the protons strikingthe patient 2130.

Still referring to FIG. 20, the main controller 130, connected to thecamera or detector 2040 output, compares the actual proton beam position269 with the planned proton beam position and/or a calibration referenceto determine if the actual proton beam position 269 is within tolerance.The proton beam verification system 2000 preferably is used in at leasttwo phases, a calibration phase and a proton beam treatment phase. Thecalibration phase is used to correlate, as a function of x-, y-positionof the glowing response the actual x-, y-position of the proton beam atthe patient interface. During the proton beam treatment phase, theproton beam position is monitored and compared to the calibration and/ortreatment plan to verify accurate proton delivery to the tumor 2120and/or as a proton beam shutoff safety indicator.

Patient Positioning

Referring now to FIG. 21, the patient is preferably positioned on orwithin a patient translation and rotation positioning system 2110 of thepatient interface module 150. The patient translation and rotationpositioning system 2110 is used to translate the patient and/or rotatethe patient into a zone where the proton beam can scan the tumor using ascanning system 140 or proton targeting system, described infra.Essentially, the patient positioning system 2110 performs largemovements of the patient to place the tumor near the center of a protonbeam path 268 and the proton scanning or targeting system 140 performsfine movements of the momentary beam position 269 in targeting the tumor2120. To illustrate, FIG. 21A shows the momentary proton beam position269 and a range of scannable positions 2140 using the proton scanning ortargeting system 140, where the scannable positions 2140 are about thetumor 2120 of the patient 2130. In this example, the scannable positionsare scanned along the x- and y-axes; however, scanning is optionallysimultaneously performed along the z-axis as described infra. Thisillustratively shows that the y-axis movement of the patient occurs on ascale of the body, such as adjustment of about 1, 2, 3, or 4 feet, whilethe scannable region of the proton beam 268 covers a portion of thebody, such as a region of about 1, 2, 4, 6, 8, 10, or 12 inches. Thepatient positioning system and its rotation and/or translation of thepatient combines with the proton targeting system to yield preciseand/or accurate delivery of the protons to the tumor.

Referring still to FIG. 21, the patient positioning system 2110optionally includes a bottom unit 2112 and a top unit 2114, such asdiscs or a platform. Referring now to FIG. 21A, the patient positioningunit 2110 is preferably y-axis adjustable 2116 to allow verticalshifting of the patient relative to the proton therapy beam 268.Preferably, the vertical motion of the patient positioning unit 2110 isabout 10, 20, 30, or 50 centimeters per minute. Referring now to FIG.21B, the patient positioning unit 2110 is also preferably rotatable 2117about a rotation axis, such as about the y-axis running through thecenter of the bottom unit 2112 or about a y-axis running through thetumor 2120, to allow rotational control and positioning of the patientrelative to the proton beam path 268. Preferably the rotational motionof the patient positioning unit 2110 is about 360 degrees per minute.Optionally, the patient positioning unit rotates about 45, 90, or 180degrees. Optionally, the patient positioning unit 2110 rotates at a rateof about 45, 90, 180, 360, 720, or 1080 degrees per minute. The rotationof the positioning unit 2117 is illustrated about the rotation axis attwo distinct times, t₁ and t₂. Protons are optionally delivered to thetumor 2120 at n times where each of the n times represent a differentrelative direction of the incident proton beam 269 hitting the patient2130 due to rotation of the patient 2117 about the rotation axis.

Any of the semi-vertical, sitting, or laying patient positioningembodiments described, infra, are optionally vertically translatablealong the y-axis or rotatable about the rotation or y-axis.

Preferably, the top and bottom units 2112, 2114 move together, such thatthey rotate at the same rates and translate in position at the samerates. Optionally, the top and bottom units 2112, 2114 are independentlyadjustable along the y-axis to allow a difference in distance betweenthe top and bottom units 2112, 2114. Motors, power supplies, andmechanical assemblies for moving the top and bottom units 2112, 2114 arepreferably located out of the proton beam path 269, such as below thebottom unit 2112 and/or above the top unit 2114. This is preferable asthe patient positioning unit 2110 is preferably rotatable about 360degrees and the motors, power supplies, and mechanical assembliesinterfere with the protons if positioned in the proton beam path 269

Proton Delivery Efficiency

Referring now to FIG. 22, a common distribution of relative doses forboth X-rays and proton irradiation is presented. As shown, X-raysdeposit their highest dose near the surface of the targeted tissue andthen deposited doses exponentially decrease as a function of tissuedepth. The deposition of X-ray energy near the surface is non-ideal fortumors located deep within the body, which is usually the case, asexcessive damage is done to the soft tissue layers surrounding the tumor2120. The advantage of protons is that they deposit most of their energynear the end of the flight trajectory as the energy loss per unit pathof the absorber transversed by a proton increases with decreasingparticle velocity, giving rise to a sharp maximum in ionization near theend of the range, referred to herein as the Bragg peak. Furthermore,since the flight trajectory of the protons is variable by increasing ordecreasing the initial kinetic energy or initial velocity of the proton,then the peak corresponding to maximum energy is movable within thetissue. Thus z-axis control of the proton depth of penetration isallowed by the acceleration/extraction process, described supra. As aresult of proton dose-distribution characteristics, a radiationoncologist can optimize dosage to the tumor 2120 while minimizing dosageto surrounding normal tissues.

The Bragg peak energy profile shows that protons deliver their energyacross the entire length of the body penetrated by the proton up to amaximum penetration depth. As a result, energy is being delivered, inthe distal portion of the Bragg peak energy profile, to healthy tissue,bone, and other body constituents before the proton beam hits the tumor.It follows that the shorter the pathlength in the body prior to thetumor, the higher the efficiency of proton delivery efficiency, whereproton delivery efficiency is a measure of how much energy is deliveredto the tumor relative to healthy portions of the patient. Examples ofproton delivery efficiency include:(1) a ratio of proton energydelivered to the tumor over proton energy delivered to non-tumor tissue;(2) pathlength of protons in the tumor versus pathlength in thenon-tumor tissue; and/or (3) damage to a tumor compared to damage tohealthy body parts. Any of these measures are optionally weighted bydamage to sensitive tissue, such as a nervous system element, heart,brain, or other organ. To illustrate, for a patient in a laying positionwhere the patient is rotated about the y-axis during treatment, a tumornear the heart would at times be treated with protons running throughthe head-to-heart path, leg-to-heart path, or hip-to-heart path, whichare all inefficient compared to a patient in a sitting or semi-verticalposition where the protons are all delivered through a shorterchest-to-heart; side-of-body-to-heart, or back-to-heart path.Particularly, compared to a laying position, using a sitting orsemi-vertical position of the patient, a shorter pathlength through thebody to a tumor is provided to a tumor located in the torso or head,which results in a higher or better proton delivery efficiency.

Herein proton delivery efficiency is separately described from timeefficiency or synchrotron use efficiency, which is a fraction of timethat the charged particle beam apparatus is in a tumor treatingoperation mode.

Depth Targeting

Referring now to FIGS. 23 A-E, x-axis scanning of the proton beam isillustrated while z-axis energy of the proton beam undergoes controlledvariation 2300 to allow irradiation of slices of the tumor 2120. Forclarity of presentation, the simultaneous y-axis scanning that isperformed is not illustrated. In FIG. 23A, irradiation is commencingwith the momentary proton beam position 269 at the start of a firstslice. Referring now to FIG. 23B, the momentary proton beam position isat the end of the first slice. Importantly, during a given slice ofirradiation, the proton beam energy is preferably continuouslycontrolled and changed according to the tissue mass and density in frontof the tumor 2120. The variation of the proton beam energy to accountfor tissue density thus allows the beam stopping point, or Bragg peak,to remain inside the tissue slice. The variation of the proton beamenergy during scanning or during x-, y-axes scanning is possible due tothe acceleration/extraction techniques, described supra, which allow foracceleration of the proton beam during extraction. FIGS. 23C, 23D, and23E show the momentary proton beam position in the middle of the secondslice, two-thirds of the way through a third slice, and after finalizingirradiation from a given direction, respectively. Using this approach,controlled, accurate, and precise delivery of proton irradiation energyto the tumor 2120, to a designated tumor subsection, or to a tumor layeris achieved. Efficiency of deposition of proton energy to tumor, asdefined as the ratio of the proton irradiation energy delivered to thetumor relative to the proton irradiation energy delivered to the healthytissue is further described infra.

Multi-field Irradiation

It is desirable to maximize efficiency of deposition of protons to thetumor 2120, as defined by maximizing the ratio of the proton irradiationenergy delivered to the tumor 2120 relative to the proton irradiationenergy delivered to the healthy tissue. Irradiation from one, two, orthree directions into the body, such as by rotating the body about 90degrees between irradiation sub-sessions results in proton irradiationfrom the distal portion of the Bragg peak concentrating into one, two,or three healthy tissue volumes, respectively. It is desirable tofurther distribute the distal portion of the Bragg peak energy evenlythrough the healthy volume tissue surrounding the tumor 2120.

Multi-field irradiation is proton beam irradiation from a plurality ofentry points into the body. For example, the patient 2130 is rotated andthe radiation source point is held constant. For example, the patient2130 is rotated through 360 degrees and proton therapy is applied from amultitude of angles resulting in the distal radiation beingcircumferentially spread about the tumor yielding enhanced protonirradiation efficiency. In one case, the body is rotated into greaterthan 3, 5, 10, 15, 20, 25, 30, or 35 positions and proton irradiationoccurs with each rotation position. Rotation of the patient ispreferably performed using the patient positioning system 2110 and/orthe bottom unit 2112 or disc, described supra. Rotation of the patient2130 while keeping the delivery proton beam 268 in a relatively fixedorientation allows irradiation of the tumor 2120 from multipledirections without use of a new collimator for each direction. Further,as no new setup is required for each rotation position of the patient2130, the system allows the tumor 2120 to be treated from multipledirections without reseating or positioning the patient, therebyminimizing tumor 2120 regeneration time, increasing the synchrotronsefficiency, and increasing patient throughput.

The patient is optionally centered on the bottom unit 2112 or the tumor2120 is optionally centered on the bottom unit 2112. If the patient iscentered on the bottom unit 2112, then the first axis control element142 and second axis control element 144 are programmed to compensate forthe off central axis of rotation position variation of the tumor 2120.

Referring now to FIGS. 24 A-E, an example of multi-field irradiation2400 is presented. In this example, five patient rotation positions areillustrated; however, the five rotation positions are discrete rotationpositions of about thirty-six rotation positions, where the body isrotated about ten degrees with each position. Referring now to FIG. 24A,a range of irradiation beam positions 269 is illustrated from a firstbody rotation position, illustrated as the patient 2130 facing theproton irradiation beam where a first healthy volume 2411 is irradiatedby the ingress or distal portion of the Bragg peak energy irradiationprofile. Referring now to FIG. 24B, the patient 2130 is rotated aboutforty degrees and the irradiation is repeated. In the second position,the tumor 2120 again receives the bulk of the irradiation energy and asecond healthy tissue volume 2412 receives the smaller ingress or distalportion of the Bragg peak energy. Referring now to FIGS. 24 C-E, thepatient 2130 is rotated a total of about 90, 130, and 180 degrees,respectively. For each of the third, fourth, and fifth rotationpositions, the tumor 2120 receives the bulk of the irradiation energyand the third, fourth, and fifth healthy tissue volumes 2413, 2414, 1415receive the smaller ingress or distal portion of the Bragg peak energy,respectively. Thus, the rotation of the patient during proton therapyresults in the distribution of distal energy of the delivered protonenergy to be distributed about the tumor 2120, such as to regions one tofive 2411-2415, while along a given axis, at least about 75, 80, 85, 90,or 95 percent of the energy is delivered to the tumor 2120.

For a given rotation position, all or part of the tumor is irradiated.For example, in one embodiment only a distal section or distal slice ofthe tumor 2120 is irradiated with each rotation position, where thedistal section is a section furthest from the entry point of the protonbeam into the patient 2130. For example, the distal section is thedorsal side of the tumor when the patient 2130 is facing the proton beamand the distal section is the ventral side of the tumor when the patient2130 is facing away from the proton beam.

Referring now to FIG. 25, a second example of multi-field irradiation2500 is presented where the proton source is stationary and the patient2130 is rotated. For ease of presentation, the stationary but scanningproton beam path 269 is illustrated as entering the patient 2130 fromvarying sides at times t₁, t₂, t₃, . . . , t_(n), t_(n+1) as the patientis rotated. At a first time, t₁, the distal end of the Bragg peakprofile hits a first area, A₁. The patient is rotated and the protonbeam path is illustrated at a second time, t₂, where the distal end ofthe Bragg peak hits a second area, A₂. At a third time, the distal endof the Bragg peak profile hits a third area, A₃. This rotation andirradiation process is repeated n times, where n is a positive numbergreater than four and preferably greater than about 10, 20, 30, 100, or300. As illustrated, at an n^(th) time, t_(n), if the patient 2130 isrotated further, the scanning proton beam 269 would hit a sensitive bodyconstituent 2150, such as the spinal cord or eyes. Irradiation ispreferably suspended until the sensitive body constituent is rotated outof the scanning proton beam 269 path. Irradiation is resumed at a time,t_(n+1), after the sensitive body constituent 2150 is rotated our of theproton beam path. In this manner, the Bragg peak energy is always withinthe tumor, the distal region of the Bragg peak profile is distributed inhealthy tissue about the tumor 2120, and sensitive body constituents2150 receive minimal or no proton beam irradiation.

In one multi-field irradiation example, the particle therapy system witha synchrotron ring diameter of less than six meters includes ability to:

-   -   rotate the patient through about 360 degrees;    -   extract radiation in about 0.1 to 10 seconds;    -   scan vertically about 100 millimeters;    -   scan horizontally about 700 millimeters;    -   vary beam energy from about 30 to 330 MeV/second during        irradiation;    -   vary the proton beam intensity independently of varying the        proton beam energy;    -   focus the proton beam from about 2 to 20 millimeters at the        tumor; and/or    -   complete multi-field irradiation of a tumor in less than about        1, 2, 4, or 6 minutes as measured from the time of initiating        proton delivery to the patient 2130.

Referring now to FIG. 26, two multi-field irradiation methods 2600 aredescribed. In the first method, the main controller 110 rotationallypositions 2610 the patient 2130 and subsequently irradiates 2620 thetumor 2120. The process is repeated until a multi-field irradiation planis complete. In the second method, the main controller 110simultaneously rotates and irradiates 2630 the tumor 2120 within thepatient 2130 until the multi-field irradiation plan is complete. Moreparticularly, the proton beam irradiation occurs while the patient 2130is being rotated.

The 3-dimensional scanning system of the proton spot focal point,described herein, is preferably combined with a rotation/raster method.The method includes layer wise tumor irradiation from many directions.During a given irradiation slice, the proton beam energy is continuouslychanged according to the tissue's density in front of the tumor toresult in the beam stopping point, defined by the Bragg peak, alwaysbeing inside the tumor and inside the irradiated slice. The novel methodallows for irradiation from many directions, referred to herein asmulti-field irradiation, to achieve the maximal effective dose at thetumor level while simultaneously significantly reducing possibleside-effects on the surrounding healthy tissues in comparison toexisting methods. Essentially, the multi-field irradiation systemdistributes dose-distribution at tissue depths not yet reaching thetumor.

Proton Beam Position Control

Referring now to FIGS. 27 A and B, a beam delivery and tissue volumescanning system is illustrated. Presently, the worldwide radiotherapycommunity uses a method of dose field forming using a pencil beamscanning system. In stark contrast, FIG. 27 illustrates a spot scanningsystem or tissue volume scanning system. In the tissue volume scanningsystem, the proton beam is controlled, in terms of transportation anddistribution, using an inexpensive and precise scanning system. Thescanning system is an active system, where the beam is focused into aspot focal point of about one-half, one, two, or three millimeters indiameter. The focal point is translated along two axes whilesimultaneously altering the applied energy of the proton beam, whicheffectively changes the third dimension of the focal point. The systemis applicable in combination with the above described rotation of thebody, which preferably occurs in-between individual moments or cycles ofproton delivery to the tumor. Optionally, the rotation of the body bythe above described system occurs continuously and simultaneously withproton delivery to the tumor.

For example, in the illustrated system in FIG. 27A, the spot istranslated horizontally, is moved down a vertical y-axis, and is thenback along the horizontal axis. In this example, current is used tocontrol a vertical scanning system having at least one magnet. Theapplied current alters the magnetic field of the vertical scanningsystem to control the vertical deflection of the proton beam. Similarly,a horizontal scanning magnet system controls the horizontal deflectionof the proton beam. The degree of transport along each axes iscontrolled to conform to the tumor cross-section at the given depth. Thedepth is controlled by changing the energy of the proton beam. Forexample, the proton beam energy is decreased, so as to define a newpenetration depth, and the scanning process is repeated along thehorizontal and vertical axes covering a new cross-sectional area of thetumor. Combined, the three axes of control allow scanning or movement ofthe proton beam focal point over the entire volume of the canceroustumor. The time at each spot and the direction into the body for eachspot is controlled to yield the desired radiation does at eachsub-volume of the cancerous volume while distributing energy hittingoutside of the tumor.

The focused beam spot volume dimension is preferably tightly controlledto a diameter of about 0.5, 1, or 2 millimeters, but is alternativelyseveral centimeters in diameter. Preferred design controls allowscanning in two directions with: (1) a vertical amplitude of about 100mm amplitude and frequency up to about 200 Hz; and (2) a horizontalamplitude of about 700 mm amplitude and frequency up to about 1 Hz.

In FIG. 27A, the proton beam is illustrated along a z-axis controlled bythe beam energy, the horizontal movement is along an x-axis, and thevertical direction is along a y-axis. The distance the protons movealong the z-axis into the tissue, in this example, is controlled by thekinetic energy of the proton. This coordinate system is arbitrary andexemplary. The actual control of the proton beam is controlled in3-dimensional space using two scanning magnet systems and by controllingthe kinetic energy of the proton beam. The use of the extraction system,described supra, allows for different scanning patterns. Particularly,the system allows simultaneous adjustment of the x-, y-, and z-axes inthe irradiation of the solid tumor. Stated again, instead of scanningalong an x,y-plane and then adjusting energy of the protons, such aswith a range modulation wheel, the system allows for moving along thez-axes while simultaneously adjusting the x- and or y-axes. Hence,rather than irradiating slices of the tumor, the tumor is optionallyirradiated in three simultaneous dimensions. For example, the tumor isirradiated around an outer edge of the tumor in three dimensions. Thenthe tumor is irradiated around an outer edge of an internal section ofthe tumor. This process is repeated until the entire tumor isirradiated. The outer edge irradiation is preferably coupled withsimultaneous rotation of the subject, such as about a vertical y-axis.This system allows for maximum efficiency of deposition of protons tothe tumor, as defined as the ratio of the proton irradiation energydelivered to the tumor relative to the proton irradiation energydelivered to the healthy tissue.

Combined, the system allows for multi-axes control of the chargedparticle beam system in a small space with small power supply. Forexample, the system uses multiple magnets where each magnet has at leastone edge focusing effect in each turning section of the synchrotronand/or multiple magnets having concentrating magnetic field geometry, asdescribed supra. The multiple edge focusing effects in the circulatingbeam path of the synchrotron combined with the concentration geometry ofthe magnets and described extraction system yields a synchrotron having:

-   -   a small circumference system, such as less than about 50 meters;    -   a vertical proton beam size gap of about 2 cm;    -   corresponding reduced power supply requirements associated with        the reduced gap size;    -   an extraction system not requiring a newly introduced magnetic        field;    -   acceleration or deceleration of the protons during extraction;        and    -   control of z-axis energy during extraction.

The result is a 3-dimensional scanning system, x-, y-, and z-axescontrol, where the z-axes control resides in the synchrotron and wherethe z-axes energy is variably controlled during the extraction processinside the synchrotron.

Referring now to FIG. 27B, an example of a proton scanning or targetingsystem 140 used to direct the protons to the tumor with 4-dimensionalscanning control is provided, where the 4-dimensional scanning controlis along the x-, y-, and z-axes along with intensity control, asdescribed supra. A fifth controllable axis is time. A sixth controllableaxis is patient rotation. Typically, charged particles traveling alongthe transport path 268 are directed through a first axis control element142, such as a vertical control, and a second axis control element 144,such as a horizontal control and into a tumor 2120. As described, supra,the extraction system also allows for simultaneous variation in thez-axis. Further, as described, supra, the intensity or dose of theextracted beam is optionally simultaneously and independently controlledand varied. Thus instead of irradiating a slice of the tumor, as in FIG.27A, all four dimensions defining the targeting spot of the protondelivery in the tumor are simultaneously variable. The simultaneousvariation of the proton delivery spot is illustrated in FIG. 27B by thespot delivery path 269. In the illustrated case, the protons areinitially directed around an outer edge of the tumor and are thendirected around an inner radius of the tumor. Combined with rotation ofthe subject about a vertical axis, a multi-field illumination process isused where a not yet irradiated portion of the tumor is preferablyirradiated at the further distance of the tumor from the proton entrypoint into the body. This yields the greatest percentage of the protondelivery, as defined by the Bragg peak, into the tumor and minimizesdamage to peripheral healthy tissue.

Imaging/X-Ray System

Herein, an X-ray system is used to illustrate an imaging system.

Timing

An X-ray is preferably collected either (1) just before or (2)concurrently with treating a subject with proton therapy for a couple ofreasons. First, movement of the body, described supra, changes the localposition of the tumor in the body relative to other body constituents.If the patient or subject 2130 has an X-ray taken and is then bodilymoved to a proton treatment room, accurate alignment of the proton beamto the tumor is problematic. Alignment of the proton beam to the tumor2120 using one or more X-rays is best performed at the time of protondelivery or in the seconds or minutes immediately prior to protondelivery and after the patient is placed into a therapeutic bodyposition, which is typically a fixed position or partially immobilizedposition. Second, the X-ray taken after positioning the patient is usedfor verification of proton beam alignment to a targeted position, suchas a tumor and/or internal organ position.

Positioning

An X-ray is preferably taken just before treating the subject to aid inpatient positioning. For positioning purposes, an X-ray of a large bodyarea is not needed. In one embodiment, an X-ray of only a local area iscollected. When collecting an X-ray, the X-ray has an X-ray path. Theproton beam has a proton beam path. Overlaying the X-ray path with theproton beam path is one method of aligning the proton beam to the tumor.However, this method involves putting the X-ray equipment into theproton beam path, taking the X-ray, and then moving the X-ray equipmentout of the beam path. This process takes time. The elapsed time whilethe X-ray equipment moves has a couple of detrimental effects. First,during the time required to move the X-ray equipment, the body moves.The resulting movement decreases precision and/or accuracy of subsequentproton beam alignment to the tumor. Second, the time required to movethe X-ray equipment is time that the proton beam therapy system is notin use, which decreases the total efficiency of the proton beam therapysystem.

X-Ray Source Lifetime

Preferably, components in the particle beam therapy system requireminimal or no maintenance over the lifetime of the particle beam therapysystem. For example, it is desirable to equip the proton beam therapysystem with an X-ray system having a long lifetime source, such as alifetime of about 20 years.

In one system, described infra, electrons are used to create X-rays. Theelectrons are generated at a cathode where the lifetime of the cathodeis temperature dependent. Analogous to a light bulb, where the filamentis kept in equilibrium, the cathode temperature is held in equilibriumat temperatures at about 200, 500, or 1000 degrees Celsius. Reduction ofthe cathode temperature results in increased lifetime of the cathode.Hence, the cathode used in generating the electrons is preferably heldat as low of a temperature as possible. However, if the temperature ofthe cathode is reduced, then electron emissions also decrease. Toovercome the need for more electrons at lower temperatures, a largecathode is used and the generated electrons are concentrated. Theprocess is analogous to compressing electrons in an electron gun;however, here the compression techniques are adapted to apply toenhancing an X-ray tube lifetime.

Referring now to FIG. 28, an example of an X-ray generation device 2800having an enhanced lifetime is provided. Electrons 2820 are generated ata cathode 2810, focused with a control electrode 2812, and acceleratedwith a series of accelerating electrodes 2840. The accelerated electrons2850 impact an X-ray generation source 2848 resulting in generatedX-rays that are then directed along an X-ray path 2970 to the subject2130. The concentrating of the electrons from a first diameter 2815 to asecond diameter 2816 allows the cathode to operate at a reducedtemperature and still yield the necessary amplified level of electronsat the X-ray generation source 2848. In one example, the X-raygeneration source 2848 is the anode coupled with the cathode 2810 and/orthe X-ray generation source is substantially composed of tungsten.

Still referring to FIG. 28, a more detailed description of an exemplaryX-ray generation device 2800 is described. An anode 2814/cathode 2810pair is used to generated electrons. The electrons 2820 are generated atthe cathode 2810 having a first diameter 2815, which is denoted d₁. Thecontrol electrodes 2812 attract the generated electrons 2820. Forexample, if the cathode is held at about −150 kV and the controlelectrode is held at about −149 kV, then the generated electrons 2820are attracted toward the control electrodes 2812 and focused. A seriesof accelerating electrodes 2840 are then used to accelerate theelectrons into a substantially parallel path 2850 with a smallerdiameter 2816, which is denoted d₂. For example, with the cathode heldat −150 kV, a first, second, third, and fourth accelerating electrodes2842, 2844, 2846, 2848 are held at about −120, −90, −60, and −30 kV,respectively. If a thinner body part is to be analyzed, then the cathode2810 is held at a smaller level, such as about −90 kV and the controlelectrode, first, second, third, and fourth electrode are each adjustedto lower levels. Generally, the voltage difference from the cathode tofourth electrode is less for a smaller negative voltage at the cathodeand vise-versa. The accelerated electrons 2850 are optionally passedthrough a magnetic lens 2860 for adjustment of beam size, such as acylindrical magnetic lens. The electrons are also optionally focusedusing quadrupole magnets 2870, which focus in one direction and defocusin another direction. The accelerated electrons 2850, which are nowadjusted in beam size and focused strike the X-ray generation source2848, such as tungsten, resulting in generated X-rays that pass throughan optional blocker 2962 and proceed along an X-ray path 2970 to thesubject. The X-ray generation source 2848 is optionally cooled with acooling element 2849, such as water touching or thermally connected to abackside of the X-ray generation source 2848. The concentrating of theelectrons from a first diameter 2815 to a second diameter 2816 allowsthe cathode to operate at a reduced temperature and still yield thenecessary amplified level of electrons at the X-ray generation source2848.

More generally, the X-ray generation device 2800 produces electronshaving initial vectors. One or more of the control electrode 2812,accelerating electrodes 2840, magnetic lens 2860, and quadrupole magnets2870 combine to alter the initial electron vectors into parallel vectorswith a decreased cross-sectional area having a substantially parallelpath, referred to as the accelerated electrons 2850. The process allowsthe X-ray generation device 2800 to operate at a lower temperature.Particularly, instead of using a cathode that is the size of theelectron beam needed, a larger electrode is used and the resultingelectrons 2820 are focused and/or concentrated into the requiredelectron beam needed. As lifetime is roughly an inverse of currentdensity, the concentration of the current density results in a largerlifetime of the X-ray generation device. A specific example is providedfor clarity. If the cathode has a fifteen mm radius or d₁ is about 30mm, then the area (πr²) is about 225 mm² times pi. If the concentrationof the electrons achieves a radius of five mm or d₂ is about 10 mm, thenthe area (πr²) is about 25 mm² times pi. The ratio of the two areas isabout nine (225π/25π). Thus, there is about nine times less density ofcurrent at the larger cathode compared to the traditional cathode havingan area of the desired electron beam. Hence, the lifetime of the largercathode approximates nine times the lifetime of the traditional cathode,though the actual current through the larger cathode and traditionalcathode is about the same. Preferably, the area of the cathode 2810 isabout 2, 4, 6, 8, 10, 15, 20, or 25 times that of the cross-sectionalarea of the substantially parallel electron beam 2850.

In another embodiment of the invention, the quadrupole magnets 2870result in an oblong cross-sectional shape of the electron beam 2850. Aprojection of the oblong cross-sectional shape of the electron beam 2850onto the X-ray generation source 2848 results in an X-ray beam 2970 thathas a small spot in cross-sectional view, which is preferablysubstantially circular in cross-sectional shape, that is then passedthrough the patient 2830. The small spot is used to yield an X-rayhaving enhanced resolution at the patient.

Referring now to FIG. 29, in one embodiment, an X-ray is generated closeto, but not in, the proton beam path. A proton beam therapy system andan X-ray system combination 2900 is illustrated in FIG. 29. The protonbeam therapy system has a proton beam 268 in a transport system afterthe Lamberson extraction magnet 292 of the synchrotron 130. The protonbeam is directed by the scanning/targeting/delivery system 140 to atumor 2120 of a patient 2130. The X-ray system 2905 includes an electronbeam source 2805 generating an electron beam 2850. The electron beam isdirected to an X-ray generation source 2848, such as a piece oftungsten. Preferably, the tungsten X-ray source is located about 1, 2,3, 5, 10, 15, or 20 millimeters from the proton beam path 268. When theelectron beam 2850 hits the tungsten, X-rays are generated in alldirections. X-rays are blocked with a port 2962 and are selected for anX-ray beam path 2970. The X-ray beam path 2970 and proton beam path 268run substantially in parallel as they progress to the tumor 2120. Thedistance between the X-ray beam path 2970 and proton beam path 269preferably diminishes to near zero and/or the X-ray beam path 2970 andproton beam path 269 overlap by the time they reach the tumor 2120.Simple geometry shows this to be the case given the long distance, of atleast a meter, between the tungsten and the tumor 2120. The distance isillustrated as a gap 2980 in FIG. 29. The X-rays are detected at anX-ray detector 2990, which is used to form an image of the tumor 2120and/or position of the patient 2130.

As a whole, the system generates an X-ray beam that lies insubstantially the same path as the proton therapy beam. The X-ray beamis generated by striking a tungsten or equivalent material with anelectron beam. The X-ray generation source is located proximate to theproton beam path. Geometry of the incident electrons, geometry of theX-ray generation material, and/or geometry of the X-ray beam blocker 262yield an X-ray beam that runs either substantially in parallel with theproton beam or results in an X-ray beam path that starts proximate theproton beam path an expands to cover and transmit through a tumorcross-sectional area to strike an X-ray detector array or film allowingimaging of the tumor from a direction and alignment of the protontherapy beam. The X-ray image is then used to control the chargedparticle beam path to accurately and precisely target the tumor, and/oris used in system verification and validation.

Referring now to FIG. 30, additional geometry of the electron beam path2850 and X-ray beam path 2970 is illustrated. Particularly, the electronbeam 2850 is shown as an expanded electron beam path 2852, 2854. Also,the X-ray beam path 2970 is shown as an expanded X-ray beam path 2972,2974.

Referring now to FIG. 31, a 3-dimensional (3-D) X-ray tomography system3100 is presented. In a typical X-ray tomography system, the X-raysource and detector rotationally translate about a stationary subject.In the X-ray tomography system described herein, the X-ray source anddetector are stationary and the patient 2130 rotates. The stationaryX-ray source allows a system where the X-ray source 2848 is proximatethe proton therapy beam path 268, as described supra. In addition, therotation of the patient 2130 allows the proton dosage to be distributedaround the body, rather than being concentrated on one static entranceside of the body. Further, the 3-D X-ray tomography system allows forsimultaneous updates of the tumor position relative to body constituentsin real-time during proton therapy treatment of the tumor 2120 in thepatient 2130. The X-ray tomography system is further described, infra.

In a first step of the X-ray tomography system 3100, the patient 2130 ispositioned relative to the X-ray beam path 2970 and proton beam path 268using a patient semi-immobilization/placement system, described infra.After patient 2130 positioning, a series of reference 2-D X-ray imagesare collected, on a detector array 2990 or film, of the patient 2130 andtumor 2120 as the subject is rotated about a y-axis 2117. For example, aseries of about 50, 100, 200, or 400 X-ray images of the patient arecollected as the patient is rotated. In a second example, an X-ray imageis collected with each n degrees of rotation of the patient 2130, wheren is about ½, 1, 2, 3, or 5 degrees of rotation. Preferably, about 200images are collected during one full rotation of the patient through 360degrees. Subsequently, using the reference 2-D X-ray images, analgorithm produces a reference 3-D picture of the tumor 2120 relative tothe patient's constituent body parts. A tumor 2120 irradiation plan ismade using the 3-D picture of the tumor 2120 and the patient'sconstituent body parts. Creation of the proton irradiation plan isoptionally performed after the patient has moved from the X-ray imagingarea.

In a second step, the patient 2130 is repositioned relative to the X-raybeam path 2970 and proton beam path 268 using the patientsemi-immobilization/placement system. Just prior to implementation ofthe proton irradiation plan, a few comparative X-ray images of thepatient 2130 and tumor 2120 are collected at a limited number ofpositions using the X-ray tomography system 2600 setup. For example, asingle X-ray image is collected with the patient positioned straight on,at angles of plus/minus forty-five degrees, and/or at angles ofplus/minus ninety degrees relative to the proton beam path 268. Theactual orientation of the patient 2130 relative to the proton beam path268 is optionally any orientation. The actual number of comparativeX-ray images is also optionally any number of images, though thepreferable number of comparative X-ray images is about 2 to 5comparative images. The comparative X-ray images are compared to thereference X-ray images and differences are detected. A medical expert oran algorithm determines if the difference between the reference imagesand the comparative images is significant. Based upon the differences,the medical expert or algorithm determines if: proton treatment shouldcommence, be halted, or adapted in real-time. For example, ifsignificant differences in the X-ray images are observed, then thetreatment is preferably halted and the process of collecting a reference3-D picture of the patient's tumor is reinitiated. In a second example,if the differences in the X-ray images are observed to be small, thenthe proton irradiation plan commences. In a third example, the algorithmor medical expert can adapt the proton irradiation plan in real-time toadjust for differences in tumor location resulting from changes inposition of the tumor 2120 in the patient 2130 or from differences inthe patient 2130 placement. In the third example, the adaptive protontherapy increases patient throughput and enhances precision and accuracyof proton irradiation of the tumor 2120 relative to the healthy tissueof the patient 2130.

Patient Immobilization

Accurate and precise delivery of a proton beam to a tumor of a patientrequires: (1) positioning control of the proton beam and (2) positioningcontrol of the patient. As described, supra, the proton beam iscontrolled using algorithms and magnetic fields to a diameter of about0.5, 1, or 2 millimeters. This section addresses partial immobilization,restraint, and/or alignment of the patient to insure the tightlycontrolled proton beam efficiently hits a target tumor and notsurrounding healthy tissue as a result of patient movement.

Herein, an x-, y-, and z-axes coordinate system and rotation axis isused to describe the orientation of the patient relative to the protonbeam. The z-axis represent travel of the proton beam, such as the depthof the proton beam into the patient. When looking at the patient downthe z-axis of travel of the proton beam, the x-axis refers to movingleft or right across the patient and the y-axis refers to movement up ordown the patient. A first rotation axis is rotation of the patient aboutthe y-axis and is referred to herein as a rotation axis, bottom unit2112 rotation axis, or y-axis of rotation 2117. In addition, tilt isrotation about the x-axis, yaw is rotation about the y-axis, and roll isrotation about the z-axis. In this coordinate system, the proton beampath 269 optionally runs in any direction. As an illustrative matter,the proton beam path running through a treatment room is described asrunning horizontally through the treatment room.

In this section, three examples of positioning systems are provided: (1)a semi-vertical partial immobilization system 3200; (2) a sittingpartial immobilization system 3300; and (3) a laying position 3400.Elements described for one immobilization system apply to otherimmobilization systems with small changes. For example, a headrest, ahead support, or head restraint will adjust along one axis for areclined position, along a second axis for a seated position, and alonga third axis for a laying position. However, the headrest itself issimilar for each immobilization position.

Vertical Patient Positioning/Immobilization

Referring now to FIG. 32, the semi-vertical patient positioning system3200 is preferably used in conjunction with proton therapy of tumors inthe torso. The patient positioning and/or immobilization system controlsand/or restricts movement of the patient during proton beam therapy. Ina first partial immobilization embodiment, the patient is positioned ina semi-vertical position in a proton beam therapy system. Asillustrated, the patient is reclining at an angle alpha, α, about 45degrees off of the y-axis as defined by an axis running from head tofoot of the patient. More generally, the patient is optionallycompletely standing in a vertical position of zero degrees off the ofy-axis or is in a semi-vertical position alpha that is reclined about 5,10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, or 65 degrees off of they-axis toward the z-axis.

Patient positioning constraints 3215 that are used to maintain thepatient in a treatment position, include one or more of: a seat support3220, a back support 3230, a head support 3240, an arm support 3250, aknee support 3260, and a foot support 3270. The constraints areoptionally and independently rigid or semi-rigid. Examples of asemi-rigid material include a high or low density foam or avisco-elastic foam. For example the foot support is preferably rigid andthe back support is preferably semi-rigid, such as a high density foammaterial. One or more of the positioning constraints 3215 are movableand/or under computer control for rapid positioning and/orimmobilization of the patient. For example, the seat support 3220 isadjustable along a seat adjustment axis 3222, which is preferably they-axis; the back support 3230 is adjustable along a back support axis3232, which is preferably dominated by z-axis movement with a y-axiselement; the head support 3240 is adjustable along a head support axis3242, which is preferably dominated by z-axis movement with a y-axiselement; the arm support 3250 is adjustable along an arm support axis3252, which is preferably dominated by z-axis movement with a y-axiselement; the knee support 3260 is adjustable along a knee support axis3262, which is preferably dominated by z-axis movement with a y-axiselement; and the foot support 3270 is adjustable along a foot supportaxis 3272, which is preferably dominated by y-axis movement with az-axis element.

If the patient is not facing the incoming proton beam, then thedescription of movements of support elements along the axes change, butthe immobilization elements are the same.

An optional camera 3280 is used with the patient immobilization system.The camera views the patient/subject 2130 creating a video image. Theimage is provided to one or more operators of the charged particle beamsystem and allows the operators a safety mechanism for determining ifthe subject has moved or desires to terminate the proton therapytreatment procedure. Based on the video image, the operators optionallysuspend or terminate the proton therapy procedure. For example, if theoperator observes via the video image that the subject is moving, thenthe operator has the option to terminate or suspend the proton therapyprocedure.

An optional video display 3290 is provided to the patient. The videodisplay optionally presents to the patient any of: operatorinstructions, system instructions, status of treatment, orentertainment.

Motors for positioning the patient positioning constraints 3215, thecamera 3280, and/or video display 3290 are preferably mounted above orbelow the proton transport path 268 or momentary proton scanning path269.

Respiration control is optionally performed by using the video display.As the patient breathes, internal and external structures of the bodymove in both absolute terms and in relative terms. For example, theoutside of the chest cavity and internal organs both have absolute moveswith a breath. In addition, the relative position of an internal organrelative to another body component, such as an outer region of the body,a bone, support structure, or another organ, moves with each breath.Hence, for more accurate and precise tumor targeting, the proton beam ispreferably delivered at a point in time where the position of theinternal structure or tumor is well defined, such as at the bottom ortop of each breath. The video display is used to help coordinate theproton beam delivery with the patient's respiration cycle. For example,the video display optionally displays to the patient a command, such asa hold breath statement, a breathe statement, a countdown indicatingwhen a breath will next need to be held, or a countdown untilrespiration may resume.

Sitting Patient Positioning/Immobilization

In a second partial immobilization embodiment, the patient is partiallyrestrained in a seated position 3300. The sitting restraint system usessupport structures similar to the support structures in thesemi-vertical positioning system, described supra, with an exceptionthat the seat support is replaced by a chair and the knee support is notrequired. The seated restraint system generally retains the adjustablesupport, rotation about the y-axis, camera, video, and respirationcontrol parameters described in the semi-vertical embodiment, describedsupra.

Referring now to FIG. 33, a particular example of a sitting patientsemi-immobilization system 3300 is provided. The sitting system ispreferably used for treatment of head and/or neck tumors. Asillustrated, the patient is positioned in a seated position on a chair3310 for particle therapy. The patient is further immobilized using anyof the: the head support 3240, the back support 3230, the hand support3250, the knee support 3260, and the foot support 3270. The supports3220, 3230, 3240, 3250, 3260, 3270 preferably have respective axes ofadjustment 3222, 3232, 3242, 3252, 3262, 3272 as illustrated. The chair3310 is either readily removed to allow for use of a different patientconstraint system or adapts under computer control to a new patientposition, such as the semi-vertical system.

Laying Patient Positioning/Immobilization

In a third partial immobilization embodiment, the patient is partiallyrestrained in a laying position. The laying restraint system 3400 hassupport structures that are similar to the support structures used inthe sitting positioning system 3300 and semi-vertical positioning system3200, described supra. In the laying position, optional restraint,support, or partial immobilization elements include one or more of: thehead support 3240 and the back support, hip, and shoulder 3230 support.The supports preferably have respective axes of adjustment that arerotated as appropriate for a laying position of the patient. The layingposition restraint system generally retains the adjustable supports,rotation about the y-axis, camera, video, and respiration controlparameters described in the semi-vertical embodiment, described supra.

If the patient is very sick, such as the patient has trouble standingfor a period of about one to three minutes required for treatment, thenbeing in a partially supported system can result in some movement of thepatient due to muscle strain. In this and similar situations, treatmentof a patient in a laying position on a support table 3420 ispreferentially used. The support table has a horizontal platform tosupport the bulk of the weight of the patient. Preferably, thehorizontal platform is detachable from a treatment platform. In a layingpositioning system 3400, the patient is positioned on a platform 3410,which has a substantially horizontal portion for supporting the weightof the body in a horizontal position. Optional hand grips are used,described infra. In one embodiment, the platform 3410 affixes relativeto the table 3420 using a mechanical stop or lock element 3430 andmatching key element 3435 and/or the patient 2130 is aligned orpositioned relative to a placement element 3460.

Additionally, upper leg support 3444, lower leg support 3440, and/or armsupport 3450 elements are optionally added to raise, respectively, anarm or leg out of the proton beam path 269 for treatment of a tumor inthe torso or to move an arm or leg into the proton beam path 269 fortreatment of a tumor in the arm or leg. This increases proton deliveryefficiency, as described supra. The leg supports 3440, 3444 and armsupport 3450 are each optionally adjustable along support axes or arcs3442, 3446, 3452. One or more leg support elements are optionallyadjustable along an arc to position the leg into the proton beam path269 or to remove the leg from the proton beam path 269, as describedinfra. An arm support element is preferably adjustable along at leastone arm adjustment axis or along an arc to position the arm into theproton beam path 269 or to remove the arm from the proton beam path 269,as described infra.

Preferably, the patient is positioned on the platform 3410 in an area orroom outside of the proton beam path 268 and is wheeled or slid into thetreatment room or proton beam path area. For example, the patient iswheeled into the treatment room on a gurney where the top of the gurney,which is the platform, detaches and is positioned onto a table. Theplatform is preferably lifted onto the table or slid onto the table sothat the gurney or bed need not be lifted onto the table.

The semi-vertical patient positioning system 3200 and sitting patientpositioning system 3300 are preferentially used to treatment of tumorsin the head or torso due to efficiency. The semi-vertical patientpositioning system 3200, sitting patient positioning system 3300, andlaying patient positioning system 3400 are all usable for treatment oftumors in the patient's limbs.

Support System Elements

Positioning constraints 3215 include all elements used to position thepatient, such as those described in the semi-vertical positioning system3200, sitting positioning system 3300, and laying positioning system3400. Preferably, positioning constraints or support system elements arealigned in positions that do not impede or overlap the proton beam path269. However, in some instances the positioning constraints are in theproton beam path 269 during at least part of the time of treatment ofthe patient. For instance, a positioning constraint element may residein the proton beam path 269 during part of a time period where thepatient is rotated about the y-axis during treatment. In cases or timeperiods that the positioning constraints or support system elements arein the proton beam path, then an upward adjustment of proton beam energyis preferably applied that increases the proton beam energy to offsetthe positioning constraint element impedance of the proton beam. Thistime period and energy is a function of rotational orientation of thepatient. In one case, the proton beam energy is increased by a separatemeasure of the positioning constraint element impedance determinedduring a reference scan of the positioning constraint system element orset of reference scans of the positioning constraint element as afunction of rotation about the y-axis.

For clarity, the positioning constraints 3215 or support system elementsare herein described relative to the semi-vertical positioning system3200; however, the positioning elements and descriptive x-, y-, andz-axes are adjustable to fit any coordinate system, to the sittingpositioning system 3300, or the laying positioning system 3400.

An example of a head support system is described to support, align,and/or restrict movement of a human head. The head support systempreferably has several head support elements including any of: a back ofhead support, a right of head alignment element, and a left of headalignment element. The back of head support element is preferably curvedto fit the head and is optionally adjustable along a head support axis,such as along the z-axis. Further, the head supports, like the otherpatient positioning constraints, is preferably made of a semi-rigidmaterial, such as a low or high density foam, and has an optionalcovering, such as a plastic or leather. The right of head alignmentelement and left of head alignment elements or head alignment elements,are primarily used to semi-constrain movement of the head or to fullyimmobilize the head. The head alignment elements are preferably paddedand flat, but optionally have a radius of curvature to fit the side ofthe head. The right and left head alignment elements are preferablyrespectively movable along translation axes to make contact with thesides of the head. Restricted movement of the head during proton therapyis important when targeting and treating tumors in the head or neck. Thehead alignment elements and the back of head support element combine torestrict tilt, rotation or yaw, roll and/or position of the head in thex-, y-, z-axes coordinate system.

Referring now to FIG. 35 another example of a head support system 3500is described for positioning and/or restricting movement of a human head2102 during proton therapy of a solid tumor in the head or neck. In thissystem, the head is restrained using 1, 2, 3, 4, or more straps orbelts, which are preferably connected or replaceably connected to a backof head support element 3510. In the example illustrated, a first strap3520 pulls or positions the forehead to the head support element 3510,such as by running predominantly along the z-axis. Preferably a secondstrap 3530 works in conjunction with the first strap 3520 to prevent thehead from undergoing tilt, yaw, roll or moving in terms of translationalmovement on the x-, y-, and z-axes coordinate system. The second strap3530 is preferably attached or replaceable attached to the first strap3520 at or about: (1) a forehead position 3532; (2) at a position on oneor both sides of the head 3534; and/or (3) at a position about thesupport element 3510. A third strap 3540 preferably orientates the chinof the subject relative to the support element 3510 by runningdominantly along the z-axis. A fourth strap 3550 preferably runs along apredominantly y- and z-axes to hold the chin relative to the headsupport element 3510 and/or proton beam path. The third 3540 strappreferably is attached to or is replaceably attached to the fourth strap3550 during use at or about the patient's chin position 3542. The secondstrap 3530 optionally connects 3536 to the fourth strap 3550 at or aboutthe support element 3510. The four straps 3520, 3530, 3540, 3550 areillustrative in pathway and interconnection. Any of the strapsoptionally hold the head along different paths around the head andconnect to each other in separate fashion. Naturally, a given strappreferably runs around the head and not just on one side of the head.Any of the straps 3520, 3530, 3540, and 3550 are optionally usedindependently or in combinations and permutations with the other straps.The straps are optionally indirectly connected to each other via asupport element, such as the head support element 3510. The straps areoptionally attached to the head support element 3510 using hook and looptechnology, a buckle, or fastener. Generally, the straps combine tocontrol position, front-to-back movement of the head, side-to-sidemovement of the head, tilt, yaw, roll, and/or translational position ofthe head.

The straps are preferably of known impedance to proton transmissionallowing a calculation of peak energy release along the z-axis to becalculated. For example, adjustment to the Bragg peak energy is madebased on the slowing tendency of the straps to proton transport.

Referring now to FIG. 36, still another example of a head support system3240 is described. The head support 3240 is preferably curved to fit astandard or child sized head. The head support 3240 is optionallyadjustable along a head support axis 3242. Further, the head supports,like the other patient positioning constraints, is preferably made of asemi-rigid material, such as a low or high density foam, and has anoptional covering, such as a plastic or leather.

Elements of the above described head support, head positioning, and headimmobilization systems are optionally used separately or in combination.

Still referring to FIG. 36, an example of the arm support 3250 isfurther described. The arm support preferably has a left hand grip 3610and a right hand grip 3620 used for aligning the upper body of thepatient 2130 through the action of the patient 2130 gripping the leftand right hand grips 3610, 3620 with the patient's hands 2134. The leftand right hand grips 3610, 3620 are preferably connected to the armsupport 3250 that supports the mass of the patient's arms. The left andright hand grips 3610, 3620 are preferably constructed using asemi-rigid material. The left and right hand grips 3610, 3620 areoptionally molded to the patient's hands to aid in alignment. The leftand right hand grips optionally have electrodes, as described supra.

Patient Respiration Monitoring

Preferably, the patient's respiration pattern is monitored. When asubject or patient 2130 is respiration many portions of the body movewith each breath. For example, when a subject breathes the lungs move asdo relative positions of organs within the body, such as the stomach,kidneys, liver, chest muscles, skin, heart, and lungs. Generally, mostor all parts of the torso move with each breath. Indeed, the inventorshave recognized that in addition to motion of the torso with eachbreath, various motion also exists in the head and limbs with eachbreath. Motion is to be considered in delivery of a proton dose to thebody as the protons are preferentially delivered to the tumor and not tosurrounding tissue. Motion thus results in an ambiguity in where thetumor resides relative to the beam path. To partially overcome thisconcern, protons are preferentially delivered at the same point in eachof a series of respiration cycles.

Initially a rhythmic pattern of respiration of a subject is determined.The cycle is observed or measured. For example, an X-ray beam operatoror proton beam operator can observe when a subject is respiration or isbetween breaths and can time the delivery of the protons to a givenperiod of each breath. Alternatively, the subject is told to inhale,exhale, and/or hold their breath and the protons are delivered duringthe commanded time period.

Preferably, one or more sensors are used to determine the respirationcycle of the individual. Two examples of a respiration monitoring systemare provided: (1) a thermal monitoring system and (2) a force monitoringsystem.

Referring again to FIG. 35, a first example of the thermal respirationmonitoring system is provided. In the thermal respiration monitoringsystem, a sensor is placed by the nose and/or mouth of the patient. Asthe jaw of the patient is optionally constrained, as described supra,the thermal respiration monitoring system is preferably placed by thepatient's nose exhalation path. To avoid steric interference of thethermal sensor system components with proton therapy, the thermalrespiration monitoring system is preferably used when treating a tumornot located in the head or neck, such as a when treating a tumor in thetorso or limbs. In the thermal monitoring system, a first thermalresistor 3570 is used to monitor the patient's respiration cycle and/orlocation in the patient's respiration cycle. Preferably, the firstthermal resistor 3570 is placed by the patient's nose, such that thepatient exhaling through their nose onto the first thermal resistor 3570warms the first thermal resistor 3570 indicating an exhale. Preferably,a second thermal resistor 3560 operates as an environmental temperaturesensor. The second thermal resistor 3560 is preferably placed out of theexhalation path of the patient but in the same local room environment asthe first thermal resistor 3570. Generated signal, such as current fromthe thermal resistors 3570, 3560, is preferably converted to voltage andcommunicated with the main controller 110 or a sub-controller of themain controller. Preferably, the second thermal resistor 3560 is used toadjust for the environmental temperature fluctuation that is part of asignal of the first thermal resistor 3570, such as by calculating adifference between the values of the thermal resistors 3570, 3560 toyield a more accurate reading of the patient's respiration cycle.

Referring again to FIG. 33, a second example of a monitoring system isprovided. In an example of a force respiration monitoring system, asensor is placed by the torso. To avoid steric interference of the forcesensor system components with proton therapy, the force respirationmonitoring system is preferably used when treating a tumor located inthe head, neck, or limbs. In the force monitoring system, a belt orstrap 3350 is placed around an area of the patient's torso that expandsand contracts with each respiration cycle of the patient. The belt 3350is preferably tight about the patient's chest and is flexible. A forcemeter 3352 is attached to the belt and senses the patients respirationpattern. The forces applied to the force meter 3352 correlate withperiods of the respiration cycle. The signals from the force meter 3352are preferably communicated with the main controller 110 or asub-controller of the main controller.

Respiration Control

Referring now to FIG. 37, a patient is positioned 3710 and once therhythmic pattern of the subject's respiration is determined 3720, asignal is optionally delivered to the subject to more precisely controlthe respiration frequency 3730. For example, a display screen 3290 isplaced in front of the patient directing the subject when to hold theirbreath and when to breathe. Typically, a respiration control module usesinput from one or more of the respiration sensors. For example, theinput is used to determine when the next breath exhale is to complete.At the bottom of the breath, the control module displays a hold breathsignal to the subject, such as on a monitor, via an oral signal,digitized and automatically generated voice command, or via a visualcontrol signal. Preferably, a display monitor 3290 is positioned infront of the subject and the display monitor displays respirationcommands to the subject. Typically, the subject is directed to holdtheir breath for a short period of time, such as about ½, 1, 2, 3, 5, or10 seconds. The period of time the breath is held is preferablysynchronized to the delivery time of the proton beam to the tumor, whichis about ½, 1, 2, or 3 seconds. While delivery of the protons at thebottom of the breath is preferred, protons are optionally delivered atany point in the respiration cycle, such as upon full inhalation.Delivery at the top of the breath or when the patient is directed toinhale deeply and hold their breath by the respiration control module isoptionally performed as at the top of the breath the chest cavity islargest and for some tumors the distance between the tumor andsurrounding tissue is maximized or the surrounding tissue is rarefied asa result of the increased volume. Hence, protons hitting surroundingtissue is minimized. Optionally, the display screen tells the subjectwhen they are about to be asked to hold their breath, such as with a 3,2, 1, second countdown so that the subject is aware of the task they areabout to be asked to perform.

X-Ray Synchronization with Patient Respiration

In one embodiment, X-ray images are collected in synchronization withpatient respiration. The synchronization enhances X-ray image clarity byremoving position ambiguity due to the relative movement of bodyconstituents during a patient respiration cycle.

In a second embodiment, an X-ray system is orientated to provide X-rayimages of a patient in the same orientation as viewed by a protontherapy beam, is synchronized with patient respiration, is operable on apatient positioned for proton therapy, and does not interfere with aproton beam treatment path. Preferably, the synchronized system is usedin conjunction with a negative ion beam source, synchrotron, and/ortargeting method apparatus to provide an X-ray timed with patientrespiration and performed immediately prior to and/or concurrently withparticle beam therapy irradiation to ensure targeted and controlleddelivery of energy relative to a patient position resulting inefficient, precise, and/or accurate noninvasive, in-vivo treatment of asolid cancerous tumor with minimization of damage to surrounding healthytissue in a patient using the proton beam position verification system.

An X-ray delivery control algorithm is used to synchronize delivery ofthe X-rays to the patient 2130 within a given period of each breath,such as at the top or bottom of a breath, when the subject is holdingtheir breath. For clarity of combined X-ray images, the patient ispreferably both accurately positioned and precisely aligned relative tothe X-ray beam path 2970. The X-ray delivery control algorithm ispreferably integrated with the respiration control module. Thus, theX-ray delivery control algorithm knows when the subject is respiration,where in the respiration cycle the subject is, and/or when the subjectis holding their breath. In this manner, the X-ray delivery controlalgorithm delivers X-rays at a selected period of the respiration cycle.Accuracy and precision of patient alignment allow for (1) more accurateand precise location of the tumor 2120 relative to other bodyconstituents and (2) more accurate and precise combination of X-rays ingeneration of a 3-dimensional X-ray image of the patient 2130 and tumor2120.

Referring again to FIG. 37, an example of generating an X-ray image ofthe patient 2130 and tumor 2120 using the X-ray generation device 2800or 3-dimensional X-ray generation device 2800 as a known function oftime of the patient's respiration cycle is provided. In one embodiment,as a first step the main controller 110 instructs, monitors, and/or isinformed of patient positioning 3710. In a first example of patientpositioning 3710, the automated patient positioning system, describedsupra, under main controller 110 control, is used to align the patient2130 relative to the X-ray beam path 2970. In a second example ofpatient positioning, the main controller 110 is told via sensors orhuman input that the patient 2130 is aligned. In a second step, patientrespiration is then monitored 3720, as described infra. As a firstexample of respiration monitoring, an X-ray is collected 3740 at a knownpoint in the patient respiration cycle. In a second example ofrespiration monitoring, the patient's respiration cycle is firstcontrolled in a third step of controlling patient respiration 3730 andthen as a fourth step an X-ray is collected 3740 at a controlled pointin the patient respiration cycle. Preferably, the cycle of patientpositioning 3710, patient respiration monitoring 3720, patientrespiration control 3730, and collecting an X-ray 3740 is repeated withdifferent patient positions. For example, the patient 2130 is rotatedabout an axis 2117 and X-rays are collected as a function of therotation. In a fifth step, a 3-dimensional X-ray image 3745 is generatedof the patient 2130, tumor 2120, and body constituents about the tumorusing the collected X-ray images, such as with the 3-dimensional X-raygeneration device 2800, described supra. The patient respirationmonitoring and control steps are further described, infra.

Proton Beam Therapy Synchronization with Respiration

A proton delivery control algorithm is used to synchronize delivery ofthe protons to the tumor within a given period of each breath, such asat the top or bottom of a breath, when the subject is holding theirbreath. The proton delivery control algorithm is preferably integratedwith the respiration control module. Thus, the proton delivery controlalgorithm knows when the subject is respiration, where in therespiration cycle the subject is, and/or when the subject is holdingtheir breath. The proton delivery control algorithm controls whenprotons are injected and/or inflected into the synchrotron, when an RFsignal is applied to induce an oscillation, as described supra, and whena DC voltage is applied to extract protons from the synchrotron, asdescribed supra. Typically, the proton delivery control algorithminitiates proton inflection and subsequent RF induced oscillation beforethe subject is directed to hold their breath or before the identifiedperiod of the respiration cycle selected for a proton delivery time. Inthis manner, the proton delivery control algorithm can deliver protonsat a selected period of the respiration cycle by simultaneously ornearly simultaneously delivering the high DC voltage to the second pairof plates, described supra, which results in extraction of the protonsfrom the synchrotron and subsequent delivery to the subject at theselected time point. Since the period of acceleration of protons in thesynchrotron is constant or known for a desired energy level of theproton beam, the proton delivery control algorithm is used to set an ACRF signal that matches the respiration cycle or directed respirationcycle of the subject.

The above described charged particle therapy elements are combined incombinations and/or permutations in developing and implementing a tumortreatment plan, described infra.

Developing and Implementing a Tumor Irradiation Plan

A series of steps are performed to design and execute a radiationtreatment plan for treating a tumor 2120 in a patient 2130. The stepsinclude one or more of:

-   -   positioning and immobilizing the patient;    -   monitoring patient respiration;    -   controlling patient respiration;    -   scanning the patient to determine tumor location relative to        body constituents;    -   developing a radiation treatment plan; and    -   irradiating the tumor.

In this section, an overview of developing the irradiation plan andsubsequent implementation of the irradiation plan is initiallypresented, the individual steps are further described, and a moredetailed description of the process is then described.

Referring now to FIG. 38, an overview of the system for development ofan irradiation plan and subsequent implementation of the irradiationplan 3800 is provided. Preferably, all elements of the system 3800 areunder main controller 110 control.

Initially, the tumor containing volume of the patient 2130 is positionedand immobilized 3710 in a controlled and reproducible position. Theprocess of positioning and immobilizing 3710 the patient 2310 ispreferably iterated 3812 until the position is accepted. The position ispreferably digitally recorded 3815 and is later used in a step ofcomputer controlled repositioning of the patient 3817 immediately priorto implementation of the irradiation element 3870 of the tumor treatmentplan. The process of positioning the patient in a reproducible fashionand reproducibly aligning the patient 2310 to the controlled position isfurther described, infra.

Subsequent to patient positioning 3710, monitoring 3720 and preferablycontrolling 3730 the respiration cycle of the patient 2130 is performedto yield more precise positioning of the tumor 2120 relative to otherbody constituents, as described supra. Multi-field images of the tumorare then collected 3840 in the controlled, immobilized, and reproducibleposition. For example, multi-field images are collected of the tumor2120 and the patient 2130. In one case, multi-field X-ray images arecollected with respiration control.

At this point the patient 2130 is either maintained in the treatmentposition or is allowed to move from the controlled treatment positionwhile an oncologist processes the multi-field images 3845 and generatesa tumor treatment plan 3850 using the multi-field images.

Typically, in a subsequent visit, the patient 2130 is repositioned 3917and the irradiation plan is executed or implemented 3870. The patientpositioning 3710 and patient repositioning 3817 steps are furtherdescribed, infra.

Computer Controlled Patient Repositioning

One or more of the patient positioning unit components and/or one ofmore of the patient positioning constraints are preferably undercomputer control. For example, the computer records or controls theposition of the patient positioning elements 3215, such as via recordinga series of motor positions connected to drives that move the patientpositioning elements 3215. For example, the patient is initiallypositioned 3710 and constrained by the patient positioning constraints3215. The position of each of the patient positioning constraints isrecorded and saved by the main controller 110, by a sub-controller ofthe main controller 110, or by a separate computer controller. Then,imaging systems are used to locate the tumor 2120 in the patient 2130while the patient is in the controlled position of final treatment.Preferably, when the patient is in the controlled position, multi-fieldimaging is performed, as described supra. The imaging system 170includes one or more of: MRI's, X-rays, CT's, proton beam tomography,and the like. Time optionally passes at this point while images from theimaging system 170 are analyzed and a proton therapy treatment plan isdevised. The patient optionally exits the constraint system during thistime period, which may be minutes, hours, or days. Upon, and preferablyafter, return of the patient and initial patient placement into thepatient positioning unit, the computer returns the patient positioningconstraints to the recorded positions. This system allows for rapidrepositioning of the patient to the position used during imaging anddevelopment of the multi-field charged particle irradiation treatmentplan, which minimizes setup time of patient positioning and maximizestime that the charged particle beam system 100 is used for cancertreatment.

Reproducing Patient Positioning and Immobilization

In one embodiment, using a patient positioning and immobilization system3800, a region of the patient 2130 about the tumor 2120 is reproduciblypositioned and immobilized, such as with the motorized patienttranslation and rotation positioning system 2110 and/or with the patientpositioning constraints 3215. For example, one of the above describedpositioning systems, such as (1) the semi-vertical partialimmobilization system 3200; (2) the sitting partial immobilizationsystem 3300; or (3) the laying position system 3400 is used incombination with the patient translation and rotation system 2110 toposition the tumor 2120 of the patient 2130 relative to the proton beampath 268. Preferably, the position and immobilization system 3800controls position of the tumor 2120 relative to the proton beam path268, immobilizes position of the tumor 2120, and facilitatesrepositioning the tumor 2120 relative to the proton beam path 268 afterthe patient 2130 has moved away from the proton beam path 268, such asduring development of the irradiation treatment plan 3845.

Preferably, the tumor 2120 of the patient 2130 is positioned in terms of3-D location and in terms of orientation attitude. Herein, 3-D locationis defined in terms of the x-, y-, and z-axes and orientation attitudeis the state of pitch, yaw, and roll. Roll is rotation of a plane aboutthe z-axis, pitch is rotation of a plane about the x-axis, and yaw isthe rotation of a plane about the y-axis. Tilt is used to describe bothroll and pitch. Preferably, the positioning and immobilization system3800 controls the tumor 2120 location relative to the proton beam path268 in terms of at least three of and preferably in terms of four, five,or six of: pitch, yaw, roll, x-axis location, y-axis location, andz-axis location.

Chair

The patient positioning and immobilization system 3800 is furtherdescribed using a chair positioning example. For clarity, a case ofpositioning and immobilizing a tumor in a shoulder is described usingchair positioning. Using the semi-vertical immobilization system 3200,the patient is generally positioned using the seat support 3220, kneesupport 3260, and/or foot support 3270. To further position theshoulder, a motor in the back support 3230 pushes against the torso ofthe patient. Additional arm support 3250 motors align the arm, such asby pushing with a first force in one direction against the elbow of thepatient and the wrist of the patient is positioned using a second forcein a counter direction. This restricts movement of the arm, which helpsto position the shoulder. Optionally, the head support is positioned tofurther restrict movement of the shoulder by applying tension to theneck. Combined, the patient positioning constraints 3215 controlposition of the tumor 2120 of the patient 2130 in at least threedimensions and preferably control position of the tumor 2120 in terms ofall of yaw, roll, and pitch movement as well as in terms of x-, y-, andz-axis position. For instance, the patient positioning constraintsposition the tumor 2120 and restricts movement of the tumor, such as bypreventing patient slumping. Optionally, sensors in one or more of thepatient positioning constraints 3215 record an applied force. In onecase, the seat support senses weight and applies a force to support afraction of the patient's weight, such as about 50, 60, 70, or 80percent of the patient's weight. In a second case, a force applied tothe neck, arm, and/or leg is recorded.

Generally, the patient positioning and immobilization system 3800removes movement degrees of freedom from the patient 2130 to accuratelyand precisely position and control the position of the tumor 2120relative to the X-ray beam path 2970, proton beam path 268, or animaging beam path. Further, once the degrees of freedom are removed, themotor positions for each of the patient positioning constraints arerecorded and communicated digitally to the main controller 110. Once thepatient moves from the immobilization system 3800, such as when theirradiation treatment plan is generated 3850, the patient 2130 must beaccurately repositioned before the irradiation plan is implemented. Toaccomplish this, the patient 2130 sits generally in the positioningdevice, such as the chair, and the main controller sends the motorposition signals and optionally the applied forces back to motorscontrolling each of the patient positioning constraints 3215 and each ofthe patient positioning constraints 3215 are automatically moved back totheir respective recorded positions. Hence, re-positioning andre-immobilizing the patient 2130 is accomplished from a time of sittingto fully controlled position in less than about 10, 30, 60, or 120seconds.

Using the computer controlled and automated patient positioning system,the patient is re-positioned in the positioning and immobilizationsystem 3800 using the recalled patient positioning constraint 3215 motorpositions; the patient 2130 is translated and rotated using the patienttranslation and rotation system 2120 relative to the proton beam 268;and the proton beam 268 is scanned to its momentary beam position 269 bythe main controller 110, which follows the generated irradiationtreatment plan 3850.

Although the invention has been described herein with reference tocertain preferred embodiments, one skilled in the art will readilyappreciate that other applications may be substituted for those setforth herein without departing from the spirit and scope of the presentinvention. Accordingly, the invention should only be limited by theClaims included below.

1. An apparatus for positioning a tumor of a patient for treatment withcharged particles, comprising: a computer controlled patient positioningsystem, comprising an upper body support, wherein said upper bodysupport comprises a semi-upright patient support surface, said computercontrolled positioning system configured to use recorded patientposition information in repositioning the patient when the patient sitsdown after a departure; and a charged particle irradiation systemcomprising a charged particle beam path, said charged particle beam pathpassing within about six inches of said semi-upright patient supportsurface.
 2. The apparatus of claim 1, wherein the charged particlestravel along said charged particle beam path to the tumor of thepatient.
 3. The apparatus of claim 1, wherein said semi-upright patientsupport surface is reclined from a vertical axis by less than aboutsixty-five degrees.
 4. The apparatus of claim 1, wherein said patientpositioning system further comprises: at least three of: a motorizedtorso positioning system; a motorized head positioning system; amotorized arm positioning system; a motorized back positioning system;and a motorized foot positioning system; and computer memory forrecalling individualized motor positions for any of: said motorizedtorso positioning system; said motorized head positioning system; saidmotorized arm positioning system; said motorized back positioningsystem; and said motorized foot positioning system.
 5. The apparatus ofclaim 4, wherein said charged particle irradiation system comprisescontrol of: beam energy; and beam intensity, wherein said patientpositioning system further comprises a rotatable platform, wherein saidcharged particle beam path passes above a portion of said rotatableplatform, wherein said rotatable platform comprises: a lower supportstructure, said lower support structure holding a portion of saidpatient positioning system; an upper support structure, said uppersupport structure holding: a camera; and a video screen, wherein saidpatient positioning system is configured to provide respirationinstructions on said video screen.
 6. The apparatus of claim 1, saidcharged particle irradiation system comprising: a negative ion source,said negative ion source producing negative ions; an ion beam focusinglens focusing the negative ions; a converting foil, said converting foilconverting the negative ions into the charged particles; and asynchrotron, said synchrotron comprising: a center; straight sections;and turning sections, wherein said charged particle beam path runs;about said center; through said straight sections; and through saidturning sections, wherein each of said turning sections comprises aplurality of bending magnets, wherein said circulation beam pathcomprises a length of less than sixty meters, and wherein a number ofsaid straight sections equals a number of said turning sections.
 7. Theapparatus of claim 1, said charged particle irradiation system furthercomprising a synchrotron, said synchrotron having a center, saidapparatus comprising: an extraction material; at least a one kilovoltdirect current field applied across a pair of extraction blades; and adeflector, wherein the charged particles pass through said extractionmaterial resulting in a reduced energy charged particle beam, whereinthe reduced energy charged particle beam passes between said pair ofextraction blades, and wherein the direct current field redirects thereduced energy charged particle beam through said deflector, whereinsaid deflector yields extracted charged particles.
 8. The apparatus ofclaim 1, further comprising: an X-ray generation source located withinforty millimeters of the charged particle beam path, wherein said X-raysource maintains a single static position: (1) during use of said X-raysource and (2) during tumor treatment with the charged particles,wherein X-rays emitted from said X-ray source run substantially inparallel with the charged particle beam path, wherein said X-raygeneration source comprises a tungsten anode; and a treatment controldelivery system integrating use of said X-ray generation source withinthirty seconds of subsequent use of said charged particle irradiationsystem.
 9. The apparatus of claim 1, further comprising: a respirationsensor configured to generate a respiration signal, said respirationsignal corresponding to a respiration cycle of the patient; a rotatableplatform holding the patient, wherein said rotatable platform rotatesthrough at least one hundred eighty degrees during an irradiation periodof the patient, wherein an X-ray generation source is timed using saidrespiration signal to produce X-ray images at a set point in therespiration cycle, wherein said X-ray images represent greater than tenrotation positions of said rotatable platform, and wherein the X-rayimages combine to form a three-dimensional image of the tumor, whereinsaid charged particle irradiation system further comprises a synchrotroncomprising multi-axis control, said multi-axis control comprisingcontrol of: an energy; and an intensity, wherein said control of saidenergy and said control of said intensity occurs during extraction. 10.The apparatus of claim 1, wherein said charged particle irradiationsystem further comprises: a synchrotron; and a rotatable platform,wherein said rotatable platform supports said patient positioningsystem; wherein said charged particle beam path runs through saidsynchrotron and terminates above said rotatable platform; wherein saidrotatable platform rotates at least ninety degrees during an irradiationperiod, and wherein said rotatable platform rotates to at least fiveirradiation positions during said irradiation period.
 11. A method forpositioning a tumor of a patient for treatment with charged particles,comprising the steps of: positioning the patient with a computercontrolled patient positioning system configured to use recorded patientposition information in repositioning the patient when the patient sitsdown after a departure, said patient positioning system comprising anupper body support, wherein said upper body support comprises asemi-upright patient support surface; and irradiating the tumor of thepatient with the charged particles from a charged particle system, saidcharged particle system comprising a charged particle beam path, saidcharge particle beam path passing within about six inches of saidsemi-upright patient support surface, wherein the charged particlestravel along said charged particle beam path to the tumor of thepatient.
 12. The method of claim 11, wherein said semi-upright patientsupport surface comprises a reclined position from a vertical axis ofless than about sixty-five degrees.
 13. The method of claim 11, furthercomprising the steps of: said patient positioning systemsemi-restraining movement of the patient using at least three of: amotorized torso positioning system; a motorized head positioning system;a motorized arm positioning system; a motorized back positioning system;and a motorized foot positioning system; and recalling from a computermemory individualized motor positions for any of: said motorized torsopositioning system; said motorized head positioning system; saidmotorized arm positioning system; said motorized back positioningsystem; and said motorized foot positioning system.
 14. The method ofclaim 13, further comprising the steps of: after said step ofpositioning, collecting multi-field images of the tumor in the patient;developing a tumor irradiation plan; repositioning the tumor using saidpatient positioning system; and repeating said step of irradiating in atleast four rotation positions.
 15. The method of claim 11, furthercomprising the steps of: varying intensity of the charged particlesdependent upon efficiency of delivery of energy of the charged particleswithin the tumor versus delivery of energy of the charged particles tohealthy tissue of the patient; holding the patient with a rotatableplatform, said rotatable platform holding at least a portion of saidpatient positioning system; rotating the patient on said rotatableplatform; delivering the charged particles to the tumor of the patientfrom a synchrotron of said charged particle system during said step ofrotating the patient; distributing ingress energy of the chargedparticles to at least ten areas about the tumor; generating arespiration signal with a respiration sensor, said respiration signalcorresponding to a respiration cycle of the patient; and timing deliveryof the charged particles to the tumor at a set point in said respirationcycle using said respiration signal.
 16. The method of claim 11, furthercomprising the step of: controlling a magnetic field in a bending magnetof a synchrotron in said charged particle system, said bending magnetcomprising: a tapered iron based core adjacent a gap, said corecomprising a surface polish of less than about ten microns roughness;and a focusing geometry comprising: a first cross-sectional distance ofsaid iron based core forming an edge of said gap, a secondcross-sectional distance of said iron based core not in contact withsaid gap, wherein said second cross-sectional distance is at least fiftypercent larger than said first cross-sectional distance, said firstcross-sectional distance running parallel said second cross-sectionaldistance.
 17. The method of claim 11, further comprising the steps of:controlling an energy of the charged particle using an accelerator insaid charged particle system, said accelerator comprising: a set of atleast ten coils; a set of at least ten wire loops; and a set of at leastten microcircuits, each of said microcircuits integrated to one of saidloops, wherein each of said loops completes at least one turn about atleast one of said coils; and using a radio-frequency synthesizer,sending a low voltage signal to each of said microcircuits, each of saidmicrocircuits amplifying said low voltage signal yielding anacceleration voltage.
 18. The method of claim 11, further comprising thestep of: monitoring both a horizontal position of the charged particlesand a vertical position of the charged particles in said chargedparticle beam path using a coating on a foil, said coating comprising alayer yielding a localized photonic signal when struck by the chargedparticles.
 19. The method of claim 11, further comprising the step of:increasing an intensity of the charged particles when targeting a distalportion of the tumor, wherein said distal portion of said tumor changeswith rotation of the patient on a platform rotating to at least tendistinct rotational positions in a period of less than one minute duringirradiation of the tumor by the charged particles, said platform holdingthe patient.